AOG - Anthem Oil & Gas Inc.

To make an offer, we need some information to help us value your interests. Please fill out this information completely (your information will remain private) and submit. We may require more detailed information, including check stub detail or payment history. Email or contact us here.

Title:

First Name:

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Last Name:

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Mailing Address:

City:

State:

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Zip Code:

Daytime Phone:

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Evening Phone:

Fax:

Email:

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Confirm Email:

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County and State Where Property or Lease Is Located:

Select AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY *

Estimation of Monthly Income:

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Do you have a copy of your possession deed or from whom you acquired it?

Do you have a copy of your tax statement and have all taxes been paid to date?

Additional Information, Questions or Comments: