Service Request Form

* indicates required field

Shipper Information

Company *

Contact *

Address *

City *

State *

ZIP Code *

Telephone *

Fax

Email *

Contract Requirements

Maximum Daily Transportation Quantity (Dekatherms) *

Receipt Point(s) (1) *

Delivery Point(s) (2) *

Quantity (DTH/D) *

Receipt Point(s) (1)

Delivery Point(s) (2)

Quantity (DTH/D)

Receipt Point(s) (1)

Delivery Point(s) (2)

Quantity (DTH/D)

Receipt Point(s) (1)

Delivery Point(s) (2)

Quantity (DTH/D) *

Service Commencement Date *

Contract Term (15 year minimum required) *

Other

Please specify other service enhancements or flexibility, such as firm, non-ratable, hourly swing service, that may be of interest. This information will not affect the validity of the service request. The incorporation of any such service enhancement or flexibility into this project will be at Florida Southeast Connection’s sole discretion and further will be dependent upon project economics, timing and requests for service received during this Open Season.