1. Company requesting Transportation Service:
Complete Legal Name:	__________________________________
Mailing Address:	__________________________________
	__________________________________
Phone:	__________________________________
Company Contact:	__________________________________

2. Company Classification:
LDC	Intrastate Pipeline	Producer
Enduser	Interstate Pipeline	Marketer
3. Service Requested:
Firm	Interruptible

4. Volume:
Firm Contract Demand:	_________________________ MMBtu / Day
Receipt Point:	_________________________
Delivery Point:	_________________________
Interruptible MDQ:	_________________________ MMBtu / Day
Receipt Point:	_________________________
Delivery Point:	_________________________
Total Projected Transportation Quantity: ________ MMBtu Over the initial term of the agreement

5. Requested Discounted Transportation Rates:
Firm Transportation:
Reservation Rate:	_________________________ MMBtu / Day
Commodity Rate:	_________________________ MMBtu / Day
Interruptible Transportation:
Reservation Rate:	_________________________ MMBtu / Day
Commodity Rate:	_________________________ MMBtu / Day
Note: FERC's Annual Charge Adjustment, currently $0.0020/MMBtu, is applicable to all service provided

6. Term:
Date Service is to Commence:	_________________________
Date Service is to Terminate:	_________________________

7. Are you an affiliate of WestGas InterState:
Yes	No
If Yes, explain:	________________________________________
8. Is your gas supplier an affiliate of WestGas InterState:
Yes	No
If Yes, explain:	________________________________________

9. If Yes to #8, attach a statement of:

Whether and by how much the cost of gas to the affiliated marketer exceeds the price received for the sale of the gas by the affiliated marketer after deducting associated costs, including those incurred for transportation.

10. Transportation pursuant to C.F.R. part 281, Subpart B:
Producing Area:	______________________________
LDC or Intrastate Pipeline Company Name
that gas is being transported for:	______________________________

11. State in which the ultimate end-user of gas is located:
State:	______________________________

12. Is any of the  transported gas subject to take-or-pay relief:
Yes	No	If Yes, What Amount:	______________

Submitter Information:
Request Submitted By:	___________________________________
Date of Request:	___________________________________

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(For WestGas InterState Use Only)
Date Received:	__________________________________
Approved:	__________________________________
Denied:	__________________________________
Reason for Denial:	__________________________________
	__________________________________
By:	__________________________________
Title:	__________________________________
Date:	__________________________________