<p> APPLICATION AND AUTHORIZATION FOR EFT / DIRECT DEPOSIT</p><p>Request Type: ☐ New Application ☐ Change ☐ Cancel</p><p>OWNER NAME: ______OWNER ID: ______SOCIAL SECURITY OR TAX ID#: ______ADDRESS: ______CITY: ______STATE: ______ZIP: ______TELEPHONE: ______FAX: ______EMAIL: ______</p><p>NAME ON BANK ACCOUNT: ______ROUTING NUMBER (9 DIGITS): ______ACCOUNT NUMBER: ______</p><p>ACCOUNT TYPE (select one): ☐ Checking ☐ Savings BANK NAME: ______BANK CITY, STATE: ______</p><p>I hereby authorize Fair Oil Ltd. to deposit my royalty payments into the account listed above by Electronic Funds Transfer (EFT). I agree to give Fair Oil Ltd. 30 days advance written notice of any change in these payment instructions. Further, I agree that Fair Oil Ltd. will not be liable for any loss, claim, damages, or interest incurred due to failure to give such notice, due to incorrect or incomplete information supplied by me or by my bank, or due to an error or tardiness on the part of my bank in depositing funds to my account. OWNER SIGNATURE: ______TITLE (IF APPLICABLE): ______DATE: ______</p><p>OWNER SIGNATURE: ______DATE: ______*Second signature required for accounts with more than one owner (i.e. John and Suzie Smith)</p><p>*IT IS REQUIRED THAT YOU ATTACH A VOIDED CHECK OR COPY OF A VOIDED CHECK* DEPOSIT SLIPS CANNOT BE USED</p><p>PLEASE ALLOW 30-60 DAYS (2 PAYMENT CYCLES) FOR EFT/DIRECT DEPOSIT ENROLLMENT TO BE PROCESSED</p>