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Royalties

All fields are required. Please provide exact, accurate responses from your documentation to each question. The offer we make will be based upon the information you provide; HELP US HELP YOU!

YOUR INFORMATION  
First & last name
Address including city, state and ZIP
Email address
Home phone
Cell phone
PURCHASER (OIL COMPANY) INFORMATION  

Purchaser name

County and state of your royalties
OIL ROYALTY REVENUE INFORMATION
The oil royalty check date and check amount of your last six checks: (If you don’t have six checks, then just list what you do have.)		  
Date: Amount:
Date: Amount:
Date: Amount:
Date: Amount:
Date: Amount:
Date: Amount:
 
 
The Net Royalty Income as reported on last year's Federal Income Tax Form 1099: (You do not have to include the 1099 information if you don’t have it.)
Year: Amount: