Request for Gas Transportation Service by G6PjQR

VIEWS: 5 PAGES: 3

									                                                                                                                  For PSCo Use Only:
                                                                               Fax To: 303-571-7001               Transpt Agree #: ______________________

                       PUBLIC SERVICE COMPANY            New Meter Required:

                                    STANDARD FORM OF REQUEST FOR
                                     GAS TRANSPORTATION SERVICE
                                      Date:
                                  *Shipper:
                                 Mailing &
                            Notice Address:
                            Billing Address:

                           Contact Name:                                                                      State of Incorporation:
SHIPPER INFO




                                Phone #:                                                                                   Fax #:
                                Tax ID#: *

                       Emergency Contacts:                                     For gas flow and other communications. Three preferred.
                                 During 1                                                                 Phone 1
                        Business Hours 2                                                                        2
                                        3                                                                       3
                                     After 1                                                                      1
                            Business Hours 2                                                                      2
                                           3                                                                      3
                       * If Shipper is different from Receiving Party, then Shipper must include written authorization from Receiving Party to act on its' behalf.

                        *Receiving Party:
                           Mailing Address:
                           Contact Name:
RECEIVING PARTY INFO




                                Phone #:                                                                 Fax #:

                       Receiving Party Customer Service:
                       Existing (circle one): Prior Contract #: _________________ Requested Service (circle one)
                                                                   New Facility

                        Interruptible Sales      Interruptible Transport                              Interruptible Transport           Firm Transport
                        Firm Sales              Firm Transport                                        Other                             Firm Capacity & Supply


                       If converting from sales to transport, Electronic Meter Installation form(s) provided by (check one):
                                                                                                                            PSCo
                                                                                                                          Shipper
                       * Attach list showing the above information for each Receiving Party.

                                       INTERRUPTIBLE SERVICE                                                              Anual                     MTDQ
                                     Receiving Party* & Facility Address                                               Quantity (Dth)         On Peak Demand Qty
SERVICE INFO




                                              FIRM SERVICE                                                                Anual                  Firm Capacity
                                     Receiving Party* & Facility Address                                               Quantity (Dth)          Peak Day Quantity




                       * If more than two, attach list showing the above information for each.                                        Total
                       FIRM SUPPLY RESERVATION PEAK DAY QUANTITY




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                      PUBLIC SERVICE COMPANY
                                                          STANDARD FORM OF REQUEST FOR
                                                           GAS TRANSPORTATION SERVICE
SVC INFO




                                        Requested Date of Service to Commence:
                                        Requested Date of Service to Terminate:



                                               Firm Transportation Primary Receipt Point(s)                                           *Firm Receipt Point
TRANSPORTATION INFO




                                         (not needed for Interruptible Transportation Requests)                                       Daily Quantity (Dth)




                                                                                                                              Total
                      * Firm Receipt Point Quantity should not include fuel %, and Total Quantity cannot exceed Peak Day Quantity.

                              Nominating
                                 *Agent:
                          Mailing Address:
NOM AGENT




                          Contact Name:                                                            Phone
                                                                                                   Fax #:
                      Emergency Contacts During:
                           Business Hours:
                             After Hours:
                      * Receives Quantity Determination Detail reports.
BILLING AGENT




                                     Billing
                                     Agent:
                             Mailing Addr:
                          Contact Name:
                               Phone #:                                                            Fax #:
                      * Receives Billing Summary.

                           Submitted By:
                                  Name:
                                   Title:
                                   Date:
APPROVAL




                                                                                PSCo Use Only
                                                                                                                                 Date:
                             Approved:                                                          Agency Designation Received: _______________
                                  Date:                                                         Meter Request Completed: __________________
                                 Name:                                                          Imbalance transfer letter submitted with request (y/n)
                                  Title:
                         Transport Rep:




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