American Midstream (AlaTenn), LLC

Fifth Revised Volume No. 1

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Effective Date: 05/01/2010, Docket: RP10-493-000, Status: Effective

Original Sheet No. 340 Original Sheet No. 340

TRANSPORTATION SERVICE REQUEST FORM - (continued)

D. Subpart G of the Commission's Regulations, on

behalf of Shipper(s) other than interstate

pipeline.

Name of Company/Companies

E. Other. Specify what Commission authorization is

being requested.

Name of Company/Companies

(AlaTenn reserves the right to require proof that Shipper's

request meets the requirements of the applicable Commission

Regulations.)

6. If Shipper is not a local distribution company and is

requesting service be performed by AlaTenn for Shipper

acting as agent for another entity, please specify the

full legal name of such entity.

*7. The intended use of the gas is:

system supply

end use by industry or commerce

other (fill in)

and, if the Shipper is not a local distribution company

and the gas is for other than system supply, please

provide the full legal name of the ultimate recipient,

and the location (i.e., state) of the ultimate Delivery

Point of the gas to be transported (i.e., if ultimate

recipient is an end user, location(s) of plant(s) where

gas is to be consumed):

8. Date service is proposed to commence: