K N Wattenberg Transmission LLC

First Revised Volume No. 1

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Effective Date: 05/22/1998, Docket: RP98-192-000, Status: Effective

Original Sheet No. 117 Original Sheet No. 117 : Effective

 

TRANSPORTATION SERVICE REQUEST FORM

 

SHIPPER INFORMATION

 

Complete Legal name of Shipper: _______________________________________

State of Incorporation: _______________________________________

Taxpayer I.D. Number: _______________________________________

 

Address: _____________________ For Billing: ___________________

_____________________ ___________________

_____________________ ___________________

Phone: _____________________ Phone: ___________________

Fax: _____________________ Fax: ___________________

 

For Notices: For Scheduling and Volume

Information:

 

(Include street address for express service)

 

Contact Name:_____________________ ___________________

_____________________ ___________________

_____________________ ___________________

Phone: _____________________ Phone: ___________________

Fax: _____________________ Fax: ___________________

 

Shipper is: ___ Local Distribution ___ Intrastate Pipeline

Company

___ Interstate Pipeline ___ Producer

___ End User ___ Marketer

___ Other (specify) _____________________________________

 

 

Name and full title of representative who will execute the written firm

or interruptible transportation service agreement with Transporter (If

signatory person is not an officer, please provide written authorization

for signature).

 

Name: ____________________________________

 

Title: ____________________________________

 

If person requesting service is an agent of Shipper, please provide

proof of authority to act as agent of Shipper and complete the

following: