ANR PIPELINE COMPANY
TRANSPORTATION SERVICE REQUEST FORM

 
Send:
 
a)  Electronically through ANR Pipeline website

b)  Fax Telecopy No. (832) 320-5677 
     Verification No. (832) 320-5474

c)  Mail Transportation Services
      ANR Pipeline Company
      P.O. Box 2446
      Houston, Texas 77252-2446
 
   INFORMATION REQUIRED FOR VALID TRANSPORTATION REQUEST
 
1.  SHIPPER:
     *Full Legal Name:    
     *Entity ID (DUNs#):     

     *Contact Name:        
     *Contact Phone:       
      Contact Email:        
 

     Is Requestor affiliated with ANR?      
      No         Yes          ANR   
                                               ANR Affiliate
                                                % Ownership of OR     % Owned by ANR or ANR Affiliate
 
     Is Shipper affiliated with ANR?      
      No         Yes          ANR   
                                               ANR Affiliate
                                                % Ownership of OR     % Owned by ANR or ANR Affiliate
 
 
2.  TYPE OF REQUEST
     New Service
     Amended Service                       (Contract No.)
 
 
  Amendment Reason:    Change Primary Points(s) (Must extend through term of Agreement)
                                       Elevation of Secondary Point to Primary
                                       Other          (Reason)    
 
 
   If Amended Service Request is from a Capacity Release Replacement Shipper:
    Replacement Shipper Contract #:  
    Releasing Shipper Contract #:       
 
 
 
3.  CONTRACT TERM      * From:      To:    
                                       Amendment Effective Date:   
 
                                       (Agreements for Rate Schedule FSS of at least twelve (12) consecutive
                                       months and for Rate Schedule STS must end on March 31)
 
 
4.   * RATE SCHEDULE      
 
Associated Gathering Contract?        Yes     No
 
5.    CONTRACT QUANTITIES








 
6.    FURTHER AGREEMENT

     

 
7.      NOTICES

(A)    Shipper Notices

                           Address:
                                 
City,State Zip:
                          Attn:
                          Phone:
                          Fax:
                          Email:
 

(B)    Invoices and Statements           Same as above

                           Address:
                                
 City,State Zip :
                          Attn:
                          Phone:
                          Fax:
                          Email:
 
     THIS TRANSPORTATION SERVICE REQUEST IS HEREBY SUBMITTED
 
     REQUESTOR:

         (Name)
         (Address)
         (City, State, Zip)
 

    *By:               
     Title:           
     Date:           
    *Telephone:  
     Fax:            
     Email:          
 
    

     * required fields