Change of Address Form Instructions for Submittal to CHK

Change of Address Form
Instructions for Submittal to CHK
1. First, you must download and save the form to your computer.
2. Open the saved form from where you saved it on your computer.
3. Type in your information, completing all fields.
4. Check the box under TERMS OF ACCEPTANCE & SIGNATURE and type in
your complete name.
(By checking this box and typing your name, you are electronically signing the Change of
Address form and confirming that you understand that an electronic signature has the same
legal effect and can be enforced in the same way as a written signature.)
5. Click Save on the form.
6. Email the completed Change of Address form to [email protected]
Note: If you prefer to submit the Change of Address form by postal mail,
follow instructions 1-4 above, then print the completed form and mail to:
Chesapeake Operating, L.L.C.
Attn: Owner Relations
P.O. Box 18496
Oklahoma City, OK 73154-0496
ELECTRONIC CHANGE OF ADDRESS FORM
I, ____________________________, authorize Chesapeake Operating,
affiliates/subsidiaries to change the address on my owner account.
Owner Number: ______________
L.L.C.
and/or
its
CHK Lease Number: _____________________
Last 4 Digits of Social Security # / Taxpayer ID: ____________________________
(Your Owner Number is listed under the name and address section of your revenue check stub)
Name on the Account: ____________________________________________________________________
Your Name (if you are not the owner): ________________________________________________________
(If not previously provided, please attach documentation establishing your relationship with the Account Owner for Chesapeake’s
review.)
OLD ADDRESS
NEW ADDRESS
Address
Address
City/Locality/Village
City/Locality/Village
State/Province/Region
State/Province/Region
Zip
Zip
Country
Country
Phone
Email
Apply this address change to my:
Check/Revenue Address
Correspondence Address
If neither box is selected, both addresses will be updated.
All fields must be complete or the change of address cannot be processed. After Chesapeake’s receipt and approval,
the change of address will become effective within thirty (30) days.
TERMS OF ACCEPTANCE & SIGNATURE
I, the requestor for this Change of Address Form, 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 in your name in the boxes below. A signature is required by all parties listed on the account.
___________________________
First Name
___________
Middle Initial
_________________________
Last Name
_____________
Suffix
___________________________
First Name
___________
Middle Initial
_________________________
Last Name
_____________
Suffix
Email this completed form to: [email protected]
Customer Reference ID#_______________
(for internal use only)
Form ID: eCOA 2016-02