Effective Date Needed:             

Full Legal Name of Entity (40):

                                                                     (Entity name will appear on all future contracts as it is shown here.)

      Required - Dun & Bradstreet No.:         

If assistance is needed in obtaining a D&B#, please e-mail transserv@elpaso.com

Please show the former name of this entity, if it has been changed.

Old Legal Name of Entity (40):

      Old - Dun & Bradstreet No.:         

       Entity Type:

                  Broker             End User         Gatherer    Hinshaw

                  InterstateP/L    Intrastate P/L   LDC          Marketer

                  Meter Operator Producer         Other

       GRI Member: Yes    No

       Legal Entity Type:

              Corporation       Municipality    Professional Corp

             Joint Venture     Partnership    Proprietorship

              Municipal Benefit Corp

      State of Incorporation:         

      Federal Tax ID Number:      

      FERC Party Number:            

NOTE:  New contract holders will need to access invoices on-line through Passkey.  A separate form, “License Agreement”, should be filled out for access to Passkey.

      TSP's On Which Service Is Requested:

FOR COMPLETION BY CUSTOMER TEAM

            Customer Team:             

            Account Manager:          

            Account Representative: 

            Volume Analyst:            

            Accounting Analyst:       

       Requested by:  

       Phone:                       

       Fax:                   

       E Mail: