| MoGas Pipeline, LLC |
|
Original Sheet No. 100 : Pending |
| FERC Gas Tariff |
|
|
| MoGas Pipeline, LLC |
MoGas Pipeline LLC
FORM OF TRANSPORTATION SERVICE REQUEST
SHIPPER INFORMATION
Complete legal name of Shipper:
__________________________________________
State of incorporation:
___________________________________________________
Address: _______________________ For Billing:
____________________________
_________________________
________________________________
_________________________
________________________________
Phone: ________________ Phone: __________________
Contact information for Notices: Contact information for
scheduling and
volume information:
Contact Name: _______________________
______________________________
Address (include _______________________
______________________________
street address for _______________________
______________________________
hand delivery) _______________________
______________________________
Phone: _______________________
______________________________
Email Address: _______________________
______________________________
Shipper is a(n) ____ Local Distribution Company ____
Intrastate Pipeline
____ Interstate Pipeline ____
Producer
____ End User ____
Marketer
____ Other (specify)
___________________________________
Name and full title of Officer, Managing Partner, or other
authorized person(s) who will execute the written transportation
service agreement with Transporter. (If signatory person is not
an officer, please provide written authorization for signature.)
Name: ________________________________
Title: ________________________________
If person requesting service is an agent of Shipper, please
provide proof of authority to act as agent of Shipper and
complete the following:
Legal Name of Principal: ___________________________________,
which is a(n)
____ Local Distribution Company ____ Intrastate
Pipeline
____ Interstate Pipeline ____ Producer
____ End User ____ Marketer
____ Other (specify)
____________________________________
| Issued by: David J.Ries, President |
| Issue date: 04/20/07 |
|
Effective date: 10/01/07 |