| MoGas Pipeline, LLC |
|
Original Sheet No. 101 : Pending |
| FERC Gas Tariff |
|
|
| MoGas Pipeline, LLC |
MoGas Pipeline LLC
FORM OF TRANSPORTATION SERVICE REQUEST
Page 2
SERVICE REQUESTED
Type of Service requested: ____ Firm ____ Interruptible
____ New ____ Amendment to Service Agreement dated:
_____________
SERVICE INFORMATION
Maximum Daily Quantity __________________ Dekatherms
Requested term of service:
Initial delivery date __________________
Termination date __________________
Total contract volume over life of contract
(affiliate transactions only) __________________
Dekatherms
Are additional or new facilities required for Transporter to
receive or deliver gas for the transportation service requested
herein?
____ Yes ____ No
If yes, state type of additional or new
facilities:_______________________
Provide the identity of
any immediate upstream Transporters of the gas to the
Receipt Point:
__________________________________
__________________________________
any immediate downstream Transporters of the gas from
the Delivery
Point:
___________________________________
___________________________________
The name(s) of End User(s) (must be provided at time of execution
of service agreement):
State any affiliation between Transporter and any of the
following entities:
Yes No If yes, name affiliate:
Shipper ____ ____ ___________________________________
End User ____ ____ ___________________________________
Supplier ____ ____ ___________________________________
Other* ____ ____ ___________________________________
*Describe involvement of any "Other" affiliate of Transporter in
this
transaction:
_________________________________________________________________
___________
_________________________________________________________________
___________
| Issued by: David J.Ries, President |
| Issue date: 04/20/07 |
|
Effective date: 10/01/07 |