K N Wattenberg Transmission LLC

Original Volume No. 1

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Effective Date: 04/01/1993, Docket: CP92-203-005, Status: Effective

Substitute Original Sheet No. 69 Substitute Original Sheet No. 69 : Effective

Transportation Service Request Form - cont.

RECEIPT POINT INFORMATION

On the attached Exhibit A, please list the name, precise legal location, the maximum daily receipt

quantity in Dth being requested, the heating value of the gas in Btu and the producing area of the

source of the gas to be transported for each receipt point listed. If requesting a proposed

receipt point, include a field contact, telephone number and a billing name and address for the

cost of installation.

DELIVERY POINT INFORMATION

On the attached Exhibit B, please list the name, precise legal location, the maximum

daily delivery quantity in Dth being requested, and the state(s) in which the delivered

gas will be consumed.

ORDER 497 INFORMATION

The identity of:

any immediate upstream transporters of the gas to the Point(s) of Receipt for each

Point(s) of Receipt* ___________________________________________

_________________________________________________________________________

any immediate downstream transporters of the gas from the Point(s) of Delivery for each

Point(s) of Delivery* _________________________________

The name(s) of End Users: (Must be provided at time of execution of service agreement.)

State any affiliation between Transporter and any of the following parties to this

transaction:

Yes No If yes, Name

Shipper _____ _____ _____________________________________

End User _____ _____ _____________________________________

Supplier _____ _____ _____________________________________

Other* _____ _____ _____________________________________

*Describe involvement _________________________________________________

_________________________________________________________________________