COMPANY

Reason for Request

Select One New Entity Name Change Merger/Acquisition

Party Type:

End User Marketer Interstate Pipeline Intrastate Pipeline Hinshaw Pipeline Producer/Operator Storage Operator Residential Other Distributor Electric Co-op Generator

Company Legal Name:

State of Incorporation:

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Legal Entity Type:

Corporation Sole Proprietorship Limited Partnership Partnership Other

DUNS Number:

Federal Tax ID:

* Please email a copy of your
W-9 to:  1LineNewBAID@williams.com

Physical Address:

City

State:

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Zip:

Country

USA Canada UK

Mailing Address:

City:

State:

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Zip:

Country

USA Canada UK

Telephone Number:

Fax Number:

Company Web Site:

Gulfstream Affiliate?

Yes No

(Optional) What is the nature/geographical region of your business with the pipeline?:

SSA

The 1Line System Security Administrator (SSA) must be the first 1Line system user entered for your company.
The SSA has the authority to setup, maintain, and manage security information for other users at your company.

SSA Name:

Title:

Street Address:

City:

State:

Please Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware D.C. Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan England Northern Ireland Scotland Wales

Zip:

    Country: USA Canada UK

Telephone Number:

Fax Number:

Mobile Number:

Pager Number:

SSA Work E-Mail:

Secondary E-mail:

Text Messaging E-mail:

Would the SSA like to receive critical notices via email?  Yes No

Would the SSA like to receive non-critical notices via email?    Yes No

BILLABLE/REFUNDS/PAYMENTS/PARTY CONTACT

The Billable Party Contact information will be used when mailing invoices, and other billing related correspondence, and/or refunds/payments

Contact Name:

Title:

Street Address:

City:

Billable Party Address County:

State:

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Zip:

   Country: USA Canada UK

Telephone Number:

Fax Number:

Mobile Number:

Pager Number:

Work E-Mail :

Secondary E-mail:

Text Messaging E-mail:

Invoicing/Billing correspondence should be delivered via: ONLINE U.S. Mail Priority-FedEx Priority-UPS

Priority Acct No (if FedEx or UPS selected):

Would the Billable Party Contact like to receive critical notices via email?  Yes No

Would the Billable Party Contact like to receive non-critical notices via email? Yes No

Does your company prefer check or wire for payments? Check Wire ACH       

If wire or ACH is preferred, please provide the following information, where applicable:

Bank Name:

Bank ID Transit or ABA# :

Bank Account No. :

Bank City :

Bank State :

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Swift/BIC Code:

Intermediary/Correspondent (Bank Name, Address, ABA Routing Number):

Beneficiary:

CONTRACT NOTICE PARTY CONTACT

The Contract Notice Party Contact information will be used for all Contract Notices.

Contact Name:

Title:

Street Address:

City:

State:

Please Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware D.C. Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan England Northern Ireland Scotland Wales

Zip:

     Country: USA Canada UK

Telephone Number:

Fax Number:

Mobile Number:

Pager Number:

Work E-Mail:

Secondary E-mail:

Text Messaging E-mail:

Would the Contract Notice Party Contact like to receive critical notices via email?  Yes No

Would the Contract Notice Party Contact like to receive non-critical notices via email?   Yes No

CAPACITY RELEASE CONTACT

The Capacity Release Contact is the primary contact for capacity release.

Will your company be doing Capacity Release? Yes No   If No, skip this section.

Contact Name:

Title:

Street Address:

City:

State:

Please Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware D.C. Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan England Northern Ireland Scotland Wales

Zip:

     Country: USA Canada UK

Telephone Number:

Fax Number:

Mobile Number:

Pager Number:

Work E-Mail:

Secondary E-mail:

Text Messaging E-mail:

Would this contact like to receive critical notices via email?   Yes No

Would this contact like to receive non-critical notices via email?    Yes No

BALANCE TRADE CONTACT

The Balance Trade Contact is the primary contact for the trading of imbalances.

Contact Name:

Title:

Street Address:

City:

State:

Please Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware D.C. Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan England Northern Ireland Scotland Wales

Zip:

Country: USA Canada UK

Telephone Number:

Fax Number:

Mobile Number:

Pager Number:

Work E-Mail:

Secondary E-mail:

Text Messaging E-mail:

Would this contact like to receive critical notices via email?    Yes No

Would this contact like to receive non-critical notices via email?   Yes No

Does this entity have any Parent or Affiliates currently doing business with Gulfstream? Yes   No  

This entity will be:

 An operator of a Location on Gulfstream?

Yes No

A Producer on a location on Gulfstream?

Yes No

 Will transport on Gulfstream?

Yes No

Will be an agent for "others" on Gulfstream?

Yes No

  Will have an agent helping it conduct business with Gulfstream?

Yes No

Are you currently working with anyone at Gulfstream to get this entity set up?

Yes No    If Yes, who?

PERSON SUBMITTING THIS FORM

I am the:

Refund/Billable Party Contact System Security Administrator Contract Notice Party Contact Other Contact (Entered Below) Capacity Release Contact Balance Trade Contact Agent Select One

Contact Name:

Title:

Street Address:

City:

State:

Please Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware D.C. Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan England Northern Ireland Scotland Wales

Zip:

Country: USA Canada UK

Telephone Number:

Fax Number:

Mobile Number:

Pager Number:

Work E-Mail:

Secondary E-mail:

Text Messaging E-mail:

Would you be a 1Line System user?

Yes No

Would you like to receive critical notices via email?

Yes No

Would you like to receive non-critical notices via email? 

Yes No

Gulfstream Natural Gas System, L.L.C.
Transportation Services
Attn: New BA Group
P.O. Box 1396
Houston, Texas 77251-1396