Elba Express Company, L.L.C.
Service Request Form
TheShipperlisted belowherebyrequestsservicefromElba ExpressCompany,L.L.C.(EEC)and is providing EEC the followinginformation inconnection with this request:
1.Shipper’sfulllegal name:
Dun andBradstreetnumber:
Type of Legal Entity:
If a corporation, state of incorporation:
Address:
Whether Shipper is an affiliate of EEC: Yes ______No ______
Contact Person for Critical Notices:
24-hour telephone number:
Email:
Contact Person for Invoices:
Telephone number:
Email:
2.Type ofservice requested is:
newFirm Transportation (FTS) contract(to acquire capacity from EECor a firm shipper)
modification to existingFTSserviceunder Contract No.
new interruptible transportation (ITS) contract
new interruptible park and loan (PAL) contract
3.Date service is requested to start:
End of primary term requested (forFTS service from EEC):
To beconsidered a validrequest,FTS service must be requestedto begin within 60 daysof thedate ofthe request,except if therequest involvesthe construction of facilities orthe issuance of anynecessarycertificateauthorization to EEC, oris part of an open season initiated byEECunderSection 2.1(b)(iii) ofthe General Terms and Conditions of its FERC Gas Tariff.
4.Firm Transportation Contract Quantity requested from EEC (if applicable): ______Dth per dayof Transportation Demand
(Please provide firm Receipt Point and firm Delivery Point information on Attachment 1 equal to the Transportation Demand requested.)
5.Submit Shipper’s most recent audited financial statements, annual report, Form10-K,threecreditreferences, andalist of affiliates, in order to enable EEC toevaluate Shipper’s creditworthiness.[1]
6.Ifbiddinginto an open season, pleasestate whether anyaffiliate of Shipper isbiddinginto the same open seasonand,if so, thebusiness purposeof eachaffiliatedcompany.
Shipperunderstandsthatbefore this request is deemed to be validbyEEC, EEC mustreceive this request form, completeand unrevisedas to format. Shipperherebyagrees topayEEC’s currentlyeffective transportation rate applicable to this serviceorsuchotherdiscounted or negotiatedrateagreed upon byEECand Shipper. Shipper,byitssignature,represents to EEC that the information aboveis correct andaccurate.
Shipper,byits signaturebelow,certifiesthat (i)it hasentered into or willenter into thosearrangements necessarytoassureallupstream anddownstreamtransportation will beinplace priorto thecommencement of service underthe serviceagreementrequestedherein;(ii) it has titleora currentcontractual right to acquiretitleto thegas to bedelivered to EEC fortransportation tothe deliverypoint; and (iii) if Shipperand itsaffiliate arebiddinginto the sameopen season thatShipperhas a different businesspurpose than its affiliateforenteringinto such open season.
Verytruly yours,
Signature:
Name (please print):
TItle:
Contact Person for questions about this Request:
Telephone: ______Email: ______
ATTACHMENT1
Firm Transportation Point Information
Shipper:
Receipt Point Identification Number (PIN) / Receipt Point Name or Description / Maximum Daily Receipt Quantity (Dth) / DeliveryPoint Identification Number (PIN) / Delivery Point Name or Description / Maximum Daily Delivery Quantity (Dth)Total Firm MDRQ*:______Total Firm MDDQ*:______
*Total MDRQ and Total MDDQ must equal.
[1] Maynot beapplicable ifShipperis an existingcreditworthyShipperon EEC’ssystemand its creditinformation is up to date and sufficient for the new capacity requested. However,EECmayrequireadditionalcreditinformation forincremental firm capacityorif the proposed request involves theconstruction of newfacilities.