Legal Company Name:   

Physical Address:           

Security Contact:           

(This individual will be the authorized security contact unless written notification is provided by the License Holder indicating a change or an authorized user changes the security contact on-line in PASSKEY.)

Phone Number:                Fax Number:                

E Mail Address:                Dun & Bradstreet No.: 

How many users will be using PASSKEY? (This determines the number of Login ID's provided.)

All PASSKEY Login ID's will be given to the security contact, whose responsibility it is to assign them to the authorized users.

Complete the above information and e-mail to: Jay.LeJeune@ElPaso.com or send via fax to Jay LeJeune at (713) 420-2360. El Paso Corporation will then submit a System License Agreement for execution. Upon receipt of the executed agreement, El Paso Corporation will send the PASSKEY Login ID's and passwords with detailed instructions for connecting via the Internet.

If there are any further questions, please contact your Account Representative or Jay LeJeune at (713) 420-3499.

Submitted by:                          Date of Request: