K N Interstate Gas Transmission Co.

Second Revised Volume No. 1-A

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Effective Date: 11/01/1994, Docket: RP94-397-000, Status: Effective

First Revised Sheet No. 31 First Revised Sheet No. 31 : Superseded

Superseding: Original Sheet No. 31

TRANSPORTATION SERVICE REQUEST FORM

 

SHIPPER INFORMATION

 

Complete Legal Name of Shipper: ___________________________________________

State of Incorporation: ____________________________________________________

Taxpayer I.D. No. _____________

 

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 Company ___ Intrastate Pipeline

___ 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: