Fax 403-245-7636 Phone 403-245-7651 ______________________________________________________________________________________________

1) Customer Information:

Company: *

Contact Name: *

Job Title :

Phone: *

Fax : *

E-mail:

Address:

_________________________________________________________________________________________________________

2) Service Request

Requested Onstream Date

Requested Quantity GJ/d 10³m³/d

Please complete Section "A" for Receipts, Section "B" for On system Deliveries and Section "C" for Other Pipeline Deliveries

_______________________________________________________________________________________________________

A) Receipt Information

Currently Connected to ATCO Pipelines Yes No

If Yes, Existing Point Name:

If No, Facility or Field Name:

Legal:

Facility: Single Well Multiple Wells Plant

Facility Maximum Operating Pressure (kPa) :

Facility Normal Operating Pressure (kPa):

Heating Value: MJ/m³

If a plant, please select the facilities included

Compression Dehydration Refrigeration H2S Processing

A copy of wellhead gas analysis and expected sales gas analysis, including total sulfer content must be forwarded to:

ATCO Pipelines Fax #403-245-7636.

_______________________________________________________________________________________________________

B) Delivery Information

Currently Connected to ATCO Pipelines Yes No

If Yes, Existing Point Name:

If No, Facility or Plant Name: Legal:

Required Minimum Delivery Pressure (kPa):

Gas Quality Requirements:

_______________________________________________________________________________________________________

C)Other Pipeline Delivery Information:

Firm Interruptible

Receipt locations sourcing Alliance deliveries:

_______________________________________________________________________________________________________

3) Special Customer Requirements: _______________________________________________________________________________________________________

4) ATCO Pipelines Rep

* Required field