Kentucky West Virginia Gas Company
Third Revised Volume No. 1
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Effective Date: 07/01/1993, Docket: RS92- 18-002, Status: Effective
Original Sheet No. 81 Original Sheet No. 81 : Superseded
Service Request Form (Continued)
(e) Name and full title of officer (or general partner) of Customer who will
execute service agreement with Pipeline:_____________________________
(f) Maximum Daily Contract Quantity to be delivered by Pipeline (state in dth
Maximum estimated total quantity to be gathered and/or transported during
term of service (state in dth and Mcf):
(g) Points of Receipt (see attachment)
(h) Points of Delivery (see attachment)
(i) (1) Date Service is requested to commence:__________________________
(2) Date Service is requested to terminate:_________________________
(j) If Customer is requesting service under either FTS or FGS Rate Schedules,
this Service Request Form must be accompanied by a prepayment, not to
exceed $10,000, of the total Reservation Charge provided in Rate
Schedules FTS or FGS contained in Pipeline's FERC Gas Tariff.
(k) Customer must execute and submit the attached Customer's certification.
At the time of execution of the Service Agreement, Customer shall inform
Pipeline of the state in which the ultimate consumer of the gas is located.
If Equitable Resources Energy Company (EREC) is a supplier of gas to Customer,
Customer agrees to cause EREC to inform Pipeline in the event EREC incurs a
loss on the sale to Customer and the amount of such loss.