Common use of Ballot Clause in Contracts

Ballot. This Ballot is delivered to the System Owner referenced below pursuant to the Agreement for the Construction, Ownership, and Operation of Midstream Assets in AMI Area D of Northern Pennsylvania among Statoil Pipelines, LLC, Appalachia Midstream Services, L.L.C., and Epsilon Midstream LLC (the “Agreement”). Project AFE Reference Number: (if applicable) Description of Project or proposal: Please execute this Ballot in the appropriate box below indicating approval or disapproval of the Project AFE or proposal. YES, the undersigned APPROVES the Project AFE or proposal described above. NO, the undersigned DOES NOT APPROVE the Project AFE or proposal described above. System Owner: System Owner: By: By: Name: Name: Title: Title: You must return this completed Ballot (or other written notice of your vote) to the Operator within thirty (30) days after receipt of a System Proposal or ten (10) business days after receipt of the Project AFE or proposal referenced above. If you fail to deliver a timely vote to the Operator, you will be deemed to have voted in favor of the Project AFE or proposal described above, subject to the terms of the Agreement. Return signed ballot by email, fax or mail to: Appalachia Midstream Services, L.L.C., Operator Attn: ▇▇▇▇▇▇▇ ▇▇▇▇▇▇ — Engineering Technician ▇▇▇▇ ▇ ▇▇▇▇▇▇▇ ▇▇▇. ▇▇▇▇▇▇▇▇ ▇▇▇▇, ▇▇▇▇▇▇▇▇ ▇▇▇▇▇ Phone: (▇▇▇) ▇▇▇-▇▇▇▇ Fax: (▇▇▇) ▇▇▇-▇▇▇▇ Email: ▇▇▇▇▇▇▇.▇▇▇▇▇▇@▇▇▇.▇▇▇ THIS GAS GATHERING AGREEMENT (the “Agreement”) is effective (“Effective Date”) by and between APPALACHIA MIDSTREAM SERVICES, L.L.C. (“Gatherer”), and (“Shipper”), and (“Producer”). Gatherer and Shipper may be referred to in this Agreement individually as a “Party” and collectively as the “Parties.”