East Tennessee Natural Gas Company

Second Revised Volume No. 1

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Effective Date: 11/01/1993, Docket: RS92- 33-003, Status: Effective

Original Sheet No. 273 Original Sheet No. 273 : Superseded

SERVICE REQUEST FORM

East Tennessee Natural Gas Company

P.O. Box 2511

Houston, TX 77252-2511

Attention: Transportation Marketing

Re: ____ New Service ____ Rate Schedule FT-A

____ Modification of service ____ Rate Schedule FT-GS

under Agreement No. ____ ____ Rate Schedule IT

____ Rate Schedule LNGS

____ Rate Schedule LMS-PA

____ Rate Schedule LMS-MA

___________________________ (Shipper) hereby requests service as specified above from

East Tennessee Natural Gas Company (East Tennessee) and concurrently provides the

following information in connection with this request:

1. Complete legal name of Shipper:

____________________________________________________________________

____________________________________________________________________

2. Type of legal entity and state of incorporation:

____________________________________________________________________

____________________________________________________________________

3. Type of company:

_________________ Local Distribution Company

_________________ Intrastate Pipeline

_________________ Interstate Pipeline

_________________ Producer

_________________ End-User

_________________ Marketer

_________________ Broker

_________________ Other (fill in)