Form for New and Existing Interconnects

Interconnect Request Form

Required Fields are marked with an asterisk (*).

 
 

Meter Owner Information

 
 
 
 
 
Street, City, State, Zip
 
(999-999-9999)
 
(999-999-9999)
 

Proposed Meter Site Information

Meter will be sized accordingly to volume specified. If volume changes and is significantly different than request, meter owner will be charged additional fee for appropriate sizing.

 
 
 
 
 
 
 
(Mcf/D)
 
(Mcf/D)
 
(psig)
 
(psig)
 
(psig)
 
(Mcf/D)
Yes   No
 
 
 
(Mcf/D)
 
(psig)
 
(psig)
 
(psig)
 
 
 
 
 
 
 
 
 
 
 
 
 
(ex: 39.12345)
 
(ex: -80.12345)
 
(mm/dd/yyyy)
 
 
 



I acknowledge that my shipper is required to notify the Transportation & Exchange department, using the production release/new meter form, that we have secured a gas purchase agreement. I also understand that the field tie-in will not be completed until the form is completed and sent to the T&E group. *