American Midstream (Midla), LLC
Sixth Revised Volume No. 1
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Effective Date: 05/01/2010, Docket: RP10-483-000, Status: Effective
Original Sheet No. 367 Original Sheet No. 367
*16. If Customer is not a local distribution company and is selling gas, provide the
name of purchaser(s) of the gas, contract quantity, and the effective and termination
date(s) of executed Agreement(s) between Customer and purchaser(s):
__________________________________________________________________
_____
__________________________________________________________________
_____
17. Is Customer affiliated with American Midstream (Midla), LLC?
Yes No
18. Is your supplier affiliated with American Midstream (Midla), LLC?
Yes No
19. For marketing affiliates of American Midstream (Midla), LLC, does the cost of gas
exceed the sales price, less associated costs including transportation, i.e., is the gas
being sold at a loss?
If so, by how much?
_________________________________________________________
(If applicable, Customer agrees by its signature to provide this information within twenty-
five (25) days after the month in which the transportation service occurred)
Customer will be required to meet the creditworthiness provisions of Transporter
prior to commencement of service.
Customer, by its signature, certifies to Pipeline (1) that the information above is
correct and accurate and that all necessary transportation arrangements with the
upstream and downstream Pipelines have been or will be secured prior to the
commencement of the requested transportation service, (2) that Customer will have title,
or the right to acquire title, to the gas that is to be delivered to Pipeline and (3) Customer
will be in compliance with the title provisions of Pipeline?s F.E.R.C. Gas Tariff.
By:
Its:
Date:
*This information is not required at the time of the request but is required at the
time Customer executes the Gas Transportation Contract.