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CONTACT
INFORMATION
Company Name
Contact Name
Address
Zip
Phone
Fax
Email
RECEIPT
INFORMATION (Into Fort Union System).
Requested Receipt Pressure (Psig)
EST. QUANTITY
(Mcf)
Max. Annual
Min Annual
Max. Daily
Min. Daily
Future Expansion Requirements (Mcf/d)
EST. GAS
QUALITY
Btu
Sp.Gravity
H2S
N2
CO2
FACILITY
LOCATION
Receipt Point
New or Existing Facility:
check one only.
Existing Facility
New Facility
Section
Township
Range
County
State
Other Description
Tap to be Built by: check
one only.
FORT UNION
REQUESTING PARTY
REQUESTED
CONSTRUCTION SCHEDULE
Desired Cost Estimate Completion
Date (m/d/y)
Desired Completion Date (m/d/y)
Engineering Contact/Phone #
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