PAIUTE PIPELINE COMPANY
Transportation/Storage Service Request Form
SHIPPER INFORMATION
1.Legal Name of Shipper:______
Shipper’s State of Incorporation:______
DUNS Number: ______
2.Shipper is (Check One)
______End User______Hinshaw Pipeline
______Local Distribution Company______Producer
______Interstate Pipeline______Marketer
______Intrastate Pipeline ______Other ______
3.Shipper’s Business Contact Person ______
Phone Numbers Office( )______Cell ( )______
Fax Number (____)______
4.Address:Notices To:
P.O. Box & Zip
Street & Zip
City, State Attention Telephone E-Mail
Invoices To:
P.O. Box & Zip Street & Zip City, State Attention Telephone E-Mail
SERVICE INFORMATION
5.Type of Service Requested (Check One):
______Firm Transportation (Rate Schedule FT-1)
______Interruptible Transportation (Rate Schedule IT-1)
______Firm LNG Storage (Rate Schedule LGS-1)
______Interruptible LNG Storage (Rate Schedule LGS-2)
6.This request is for (Check One):______New Service
______Amendment of Existing Service
If New Service is checked, provide the following requested quantities as applicable:
Daily Reserved Capacity (firm transportation) ______Dth/day
Daily Quantity (interruptible transportation)______Dth/day
LNG Storage Capacity (firm/interruptible storage)______Dth
If Amendment of Existing Service is checked, complete the following:
Agreement No.
Agreement Date
Change in:
From (Dth) To (Dth)
_____Daily Reserved Capacity______
_____Summer Daily Reserved Capacity______
_____Daily Quantity
(IT-1 service only)______
_____LNG Storage Capacity______
Change in Delivery Point (Addition/Deletion/Quantity or Pressure Change)
______Yes______No
Other (Specify) ______
______
7.Requested Term of Service:Commencement Date______Termination Date ______
8.Complete Exhibit A specifying the Receipt and Delivery Points requested, the maximum daily quantity applicable to each Receipt and Delivery Point, the delivery pressure applicable to each Delivery Point, and the name of the pipeline, local distribution company, or other entity that will take possession of the gas from Paiute Pipeline Company at each Delivery Point. In no event should the maximum daily quantity requested for a Delivery Point exceed the delivery capacity at that point. In addition, the sum of Shipper’s requested Delivery Point maximum daily quantities must equal Shipper’s requested Daily Reserved Capacity. If this request involves an Amendment of an Existing Service, describe on Exhibit A any requested change in Delivery Point (addition, deletion, quantity or pressure change).
REGULATORY/ “ON BEHALF OF” INFORMATION
9.All service will be provided pursuant to Subpart G of Part 284 of the Federal Energy Regulatory Commission’s (FERC) regulations, unless Shipper specifically requests that service be provided pursuant to Subpart B of Part 284 of the FERC’s regulations. Subpart B applies to certain services that are being performed on behalf of an intrastate pipeline or a local distribution company. If service is requested pursuant to Subpart B, Shipper will be required to provide certain information and a certification to verify that its requested service qualifies under Subpart B, as set forth in Section 7.3 of the General Terms and Conditions and Section 284.102 of the FERC’s regulations.
Does Shipper request service under Subpart B? (Check One): ______Yes
______No
CREDITWORTHINESS
10.Shipper is required to establish creditworthiness according to the provisions of Section 7.4 of the General Terms and Conditions. Paiute is not required to provide service on behalf of any Shipper who fails to demonstrate creditworthiness.
Shipper hereby certifies that it has title or the right to ship the gasdelivered to Paiute for transportation and has entered into or will enter into arrangements necessary to assure all upstream and downstream transportation will be in place prior to commencement of service.
Shipper certifies that the information herein is complete and accurate to the best of Shipper’s knowledge, information and belief.
Signature:
Name:
Title:
Date:
Please return this request to:
PAIUTE PIPELINE COMPANY
P.O. Box 94197
Las Vegas, NV 89193-4197
Attn: Mark Litwin
Phone No.: (702) 364-3195
Fax No.: (702) 873-3820
EXHIBIT A
to the
Transportation/Storage Service Request of
(Shipper)
to
Paiute Pipeline Company
Dated
RequestedRequested MaximumDelivery Party
Receipt DeliveryDaily QuantityPressureReceiving
Point Name(1)Point Name(1) Dth/day Psig Delivery
(1)If requesting a change to existing receipt or delivery point rights, use the first column to identify the existing point name and the second column to identify the proposed point name.