U-T Offshore System, L.L.C.

Third Revised Volume No. 1

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Effective Date: 06/01/1997, Docket: RP97-146-001, Status: Effective

Second Revised Sheet No. 109 Second Revised Sheet No. 109 : Superseded

Superseding: First Revised Sheet No. 109

U-T OFFSHORE SYSTEM

TRANSPORTATION SERVICE REQUEST FORM

(Continued)

12. Nature and Extend of Supplier's Affiliation with U-TOS or Any Partner in U-TOS

(if known):

_____________________________________________________________________________________

13. State where the ultimate end user of the gas will use such gas.

End User State of End Use

____________________ _________________________

____________________ _________________________

____________________ _________________________

14. (To be completed only if Shipper is affiliated with U-TOS or any partner in

U-TOS, and will be marketing the gas to be transported).

Amount by Which the Gas Will Be Sold At a Loss ($/Dth): __________________

15. Dun & Bradstreet Number: __________________________________

16. Internet E-Mail Address: __________________________________

17. Certified Statement

-------------------

By submitting this request, Shipper certifies that Shipper has or will have by

the time of execution of an Agreement with U-TOS, title to or right to deliver

the Gas which is to be transported and owns facilities or contractual rights

which will cause such Gas to be delivered to and received from U-TOS.

THIS TRANSPORTATION SERVICE REQUEST IS HEREBY SUBMITTED

this ______________ day of________________________________________, 19________.

By ___________________________________________________________________________

Telephone Number _____________________________________________________________