B-R Pipeline Company
Original Volume No. 1
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Effective Date: 05/01/2004, Docket: RP04-224-000, Status: Effective
Original Sheet No. 121 Original Sheet No. 121 : Effective
GENERAL TERMS AND CONDITIONS
(CONTINUED)
24. FORM OF TRANSPORTATION REQUEST
B-R PIPELINE COMPANY ("Transporter")
Transportation Request
Shipper Information
1. Shipper Name: __________________________________________________
(Legal Name of Party who will be signing Agreement)
(a) Requester: ________________________________________________
(if other than Shipper)
2. Shipper is (Check One)
_____ End User _____ Hinshaw Pipeline
_____ LDC _____ Producer
_____ Interstate Pipeline _____ Marketer
_____ Intrastate Pipeline _____ Other_____________________
(please specify)
3. Shipper's Contact Person ______________________________________
Phone Number (___)_________________________________
Telecopy Number (___)_________________________________
4. Address: Notices to: ______________________________________
P.O. Box & Zip ______________________________________
Street & Zip ______________________________________
City, State ______________________________________
Attention ______________________________________
Email Address: ______________________________________
Invoices to: ______________________________________
P.O. Box & Zip ______________________________________
Street & Zip ______________________________________
City, State ______________________________________
Attention ______________________________________
Regulatory/"On Behalf of" Information
5. Shipper hereby requests:
___ Section 311 transportation pursuant to Section 284.102 for service on
behalf of a local distribution company or an intrastate pipeline.
___ Open access transportation pursuant to Section 284.222 for service on
behalf of an interstate pipeline.
___ Open access transportation pursuant to Section 284.223 for service on
behalf of a shipper other than an interstate pipeline.
___ Not Applicable
6. If service is requested pursuant to Section 284.102 above, identify
the "on behalf of" party associated with the transportation service
requested:
Legal Name: ____________________________________________________