Name:
Address:
City:
State:
Zip Code:
Email:
Phone:
Mobile:
Fax:
Best time to contact you?
If you get a royalty check, what is the average monthly amount?
If you get a royalty check, who does it come from? (Operator)
In what state is the property located?
In what county is the property located?
Previous owner (if known)?
Additional Comments: