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“THE SAFEST WAY TO LEASE YOUR MINERALS”
Mineral Owner Contact Form
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Name
*
First
Middle
Last
Spouse
First
Middle
Last
Phone Number (Primary)
*
Phone Number (2nd)
Best Time To Call
Choose Time
9am-12pm
12pm-3pm
3pm-6pm
6pm-9-pm
Anytime 9am-9pm
Client Email
Email
Confirm Email
Client Information
Address
Address Line 1
Address Line 2
City
--- Select state ---
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District of Columbia
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Pennsylvania
Rhode Island
South Carolina
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Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
County and State
*
District or Township
Map-Parcel # or Tax-ID #
Acres
% of Ownership
Referred By:
Client Questionnaire
What Type of Service Are You Interested In?
No-Cost Leasing Consultation
Innovative Leasing & Contract Negotiation
Royalty Monitoring & Auditing (Included with Lease)
Have You Had Past Negative Experiences with an Oil and Gas Company? Please Explain the Problem(s) you've experienced.
How Did You First Hear About Us?
Currently Leased?
YES
NO
What Company?
Date of Expiration
Previously Leased?
YES
NO
What Company?
Date of Expiration (Estimate is fine)
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YYYY
2025
2024
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2019
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1934
1933
1932
1931
1930
1929
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1926
1925
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1923
1922
1921
1920
Currently Receiving Royalty Income?
YES
NO
Average Monthly Amount?
Additional Information:
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