1099 Request Form

Per Federal Law, 1099 Forms are mailed on February 1st of each year. If that day falls on a weekend, the forms are mailed the next business day. For example, if February 1st is on a Saturday, the forms would be mailed the following Monday, February 3rd.

Please allow up to two weeks for us to process your request, and two weeks for the mail to deliver your 1099 for the current

tax year before requesting a duplicate.

Return to the Information About Change of Ownership Page

Name or Business Name

Contact Person

Email

Confirm Email

Phone

So we can contact you with any questions or issues

(###)

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Last 4 digits of Social Security or Tax ID Number

For identity verification

Owner Number or Vendor Number

If known

For which tax year are you requesting this 1099

How would you like to recieve your 1099?

Please list your mailing address or fax number

If you would like to receive your 1099 by mail or fax

Is the recipient

I,

First Name

Last Name

authorize Ballard Exploration Company, Inc. and/or its affiliates/subsidiaries to change the address on my owner account. * TERMS OF ACCEPTANCE OF SIGNATURE I, the requestor for this Form 1099, warrant the truthfulness of the information provided in this submission. I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature.

Step 1: Check the box below* By checking this box and typing my name below, I am electronically signing this Change of Address Form. Step 2: Type your name in the box below. A signature is required by all parties listed on the account.

I agree to the Terms

E-Signature

If you have a change of address for your checks, please complete the Change of Address Form.

If you have an ownership change, please complete the Change of Ownership Form.