Service Request Form

Are you an Existing Customer?*
Are you Affiliated with: Southern Star, La Caisse de Depot et Placement du Quebec or Ullico Infrastructure Fund?*
- No
- Yes
Existing Service Requester Information
Service Requester Name*
Service Requester Proprietary Number*
Contact Email*
Enter Email Confirm Email
If Address has changed please check
- Yes
Address Change*
Street Address City State / Province / Region ZIP / Postal Code Country
New Service Requester Information
Service Requester Name*
Address*
Street Address City State / Province / Region ZIP / Postal Code Country
State of Formation*
Type of Legal Entity*
Tax ID Number*
Dun & Bradstreet Number*
CSI Contact Information
Security Administrator: Required for Authorizing CSI Access
- Copy Service Requester Address
Name*
Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Enter Email Confirm Email
Contracting Contact Information
- Copy Security Administrator Information
Name*
Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Enter Email Confirm Email
Invoice Primary Contact Information
- Copy Security Administrator Information
Name*
Invoicing Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Enter Email Confirm Email
Requested Term of Service
Effective Date*
MM slash DD slash YYYY
Termination Date*
MM slash DD slash YYYY
Requested Quantities
Rate Schedule Requested*
If Other please list
Will you accept less quantity*
Lesser Quantity Production
Lesser Quantity Market
Maximum Daily Transportation Quantity
Production Quantity Requested
Please enter a number greater than or equal to 0.
Market Quantity Requested
Please enter a number greater than or equal to 0.
Production- Firm Transportation
Receipt Locations
Location Number Location Name Requested MDQ
Requested Receipt Total MDQ
Delivery Locations
Location Number Location Name Requested MDQ Requested MDP
Requested Delivery Total MDQ
Market Area - Firm Transportation
Receipt Locations
Location Number Location Name Requested MDQ
Requested Receipt Total MDQ
Delivery Locations
Location Number Location Name Requested MDQ Requested MDP
Requested Delivery Total MDQ
Storage
Maximum Daily Withdrawal Quantity (MDWQ)
Maximum Storage Quantity (MSQ)*
*FSS Maximum Storage Quantity: Shall equal Shipper's Maximum Daily Withdrawal Quantity times 33
Maximum Storage (MSQ)*
*ISS Maximum Storage Quantity: Cannot exceed 45 times the Maximum Daily Withdrawal Quantity
Comments
This field is for validation purposes and should be left unchanged.

Location Number	Location Name	Requested MDQ

Location Number	Location Name	Requested MDQ	Requested MDP

Location Number	Location Name	Requested MDQ

Location Number	Location Name	Requested MDQ	Requested MDP

Existing Service Requester Information

New Service Requester Information

CSI Contact Information

Requested Term of Service

Requested Quantities

Maximum Daily Transportation Quantity

Production- Firm Transportation

Market Area - Firm Transportation

Storage