Appendix C: Contact Worksheet

Filing Oil and Gas Reports Using Electronic Media

Electronic Filing Company Contact Worksheet

        

        Operator RRC Number:    __________________________________________

        Operator Name:          __________________________________________

        Name of Agent on MEFC:  __________________________________________

        Form(s):                __________________________________________

        Efile User ID:  	



        If you are filing via the EFile System, you must enter your EFile User ID.
	If you are filing by diskette or cartridge tape and wish to receive the
	error and status reports electronically, enter your EFile User ID. By 
	entering your EFile User ID, you are acknowledging that you will not
	receive the error and status reports by postal mail.

      

        Primary Contact (Business)
     

        Name:       ______________________________________________________
    
        Phone:      ______________________________________________________

        Address:    ______________________________________________________
 
                    ______________________________________________________

 		    



        Data Processing Contact (Technical)
       

        Name:       ______________________________________________________

        Phone:      ______________________________________________________

        Address:    ______________________________________________________

                    ______________________________________________________