Carolina Gas Transmission Corporation

Original Volume No. 1

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Effective Date: 08/06/2007, Docket: RP07-519-000, Status: Effective

First Revised Sheet No. 380 First Revised Sheet No. 380 : Effective

Superseding: Original Sheet No. 380




Any party requesting service, agency authorization, or pooling on

Carolina Gas Transmission Corporation’s (“Pipeline”) system must complete this

Service Request Form, either electronically on Pipeline’s Internet Website or

on a paper copy. Completed Service Request Forms shall be sent to:


Customer Services Department

Carolina Gas Transmission Corporation

Post Office Box 11539

Columbia, South Carolina 29211-1539


No request for service shall be considered until a completed Service

Request Form is received by Pipeline’s Customer Services Department.



_______________________________ (“Requesting Party”) provides the following

information in connection with this request:


1. Type of service or agreement (check only one):


_____ Rate Schedule FT

_____ Rate Schedule IT

_____ Rate Schedule PAL

_____ Pooling Agreement

_____ Agency Authorization Agreement

_____ Capacity Release Umbrella Service Agreement

_____ Pre-qualification for Service Only


2. Date Service or Agreement is requested to Commence:_____________________


3. Requesting Party (Complete Legal Name):_________________________________


(a) Type of Legal Entity:______________________________


(b) State of Incorporation:____________________________


(c) D-U-N-S® Number:___________________________________


(d) Requesting Party is (check only one):


______Interstate Pipeline ______Intrastate Pipeline

______LDC ______End-User

______Producer ______Marketer

______Broker ______Other (specify) ____________