"_____________________________ authorizes __________________________ to act as its agent for the period of time from _____________________ through ___________________ for the purpose identified below and consents to the Transporation Providers disclosing to Agent all Transmission Customer information necessary for Agent to perform its authorized functions. "
Gas Scheduling: Yes No Contracting Yes No "Nominations, Balancing, Confirmations, Scheduled Quantity Reports and Invoicing (including storage in-ground transfers, invoice and other report review, measurement info., etc.) Imbalance Trading" Request (Long & Short Term Unsold Bidding), Amendments, Capacity Release Other, please explain: For Pipelines: Yes No For contracts listed below: Dominion Energy Questar Pipeline, LLC Dominion Energy Overthrust Pipeline, LLC Questar Southern Trails Pipeline Questar Field Services, LLC White River Hub, LLC All Pipelines or All contracts Yes: No: Shipper (Contract Holder) Agent "Party Name " "Party Name " "By (Authorized Signature) " "By (Authorized Signature) " "Name " "Name " "Title " "Title " "Date " "Date " Return Completed Information to: Dominion Energy Questar Pipeline, LLC. - Transportation Customer Service Department - QC356 P.O. Box 45360, Salt Lake City, UT 84145-0360 Tel: 801-324-5604 - Fax: 801-324-5245