Carnegie Interstate Pipeline Company

Original Volume No. 1

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Effective Date: 01/01/1995, Docket: CP93-552-003, Status: Effective

Original Sheet No. 59 Original Sheet No. 59 : Effective

Superseding: Original Sheet No. 59

GENERAL TERMS AND CONDITIONS

(Continued)

9.2 Form of Request For Service

(a) DATE OF

REQUEST:______________________________________

(b) CUSTOMER INFORMATION

Name:___________________________________________

______

Address:________________________________________

______

______________________________________________

______________________________________________

Type (check one):

____ LDC

____ Interstate Pipeline

____ Intrastate Pipeline

____ End User

____ Producer

____ Marketer/Broker

____ Other (please specify):

_______________________

(c) REQUESTER INFORMATION

Name:___________________________________________

______

Address:________________________________________

______

______________________________________________

______________________________________________

Attn:___________________________________________

______

Telephone:______________________________________

______