Name

 

   

Address

 

Suite

 

City

 

 

 State  Zip 

Phone       Office

 

Fax

 

E-mail

 

   
 

 

 Buying     Selling      Other

 

Lease Information

   

Location

 

TypeWells

 Oil  Gas     Both

Formation

 

# of Wells

     Depth

 

Last Produced 

 

YES

NO

 

Sales Price

Prodcution records available?

 

 

   

Abandoned?

 

 

   

Abandoned with equipment?

 

 

   

To be Plugged?

 

 

       

Comments :

 

 

 

   
 

Disclaimer: This is not a security

   
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