Crossroads Pipeline Company

First Revised Volume No. 1

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Effective Date: 11/01/2001, Docket: RP02- 14-000, Status: Effective

Original Sheet No. 542 Original Sheet No. 542 : Effective





IMBALANCES (if different than Billing)


Street ______________________________________________________________________________________


City ________________________________________________________________________________________


State _______________________________________________________________________________________


Zip Code ___________________________________________________________________________________


Contact Person (Mr., Mrs., Miss, Ms.) ______________________________________________________



The above shipper information detail must be established initially. Once established, only changes to this

detail must be resubmitted.


_____ 2. The Bidder is a(n)

(Please enter the appropriate code.)



1 Local Distribution Company

2 Interstate Pipeline Company

3 Intrastate Pipeline Company

4 End User

5 Producer

6 Marketer

7 Other

8 Pipeline Blanket Sales Operating Unit


3. a. Please answer the following:


Parcel Number (If not a stand-alone bid, please reflect all related parcel numbers below.)



Bid Rate (Reflect bid rate in a. or b. below. Bid rate must comport with the capacity release

offer. Choose only one option under (a) or (b) unless you want a blended rate to be considered.)


_____ a. (i) Absolute dollars and cents two-part rate

_____ (ii) Absolute dollars and cents one-part rate


_____ b. (i) Percent of maximum rate two-part rate

_____ (ii) Percent of maximum rate one-part rate


c. State Bid Offer Contingencies