Direct Deposit Form

Direct Deposit Form
Oil/Gas Revenue Payments
Joint Venture
NEW application
Change
Cancel
*For your protection, please note that ALL five sections below must be completed.
FIRST*
–
Print the Owner Name, Owner Mailing Address, Owner and TIN or Social Security Number:
Owner Name
Owner Mailing Address
SECOND*
City/State
TIN or Social Security Number
Zip Code
– Select the Owner’s Account Type (check one):
CHECKING
THIRD*
Owner Number (minimum 9 digits)
SAVINGS
IS THIS AN ADDRESS CHANGE?
– Sign and date the enrollment form:
I authorize ConocoPhillips Company and my financial institution referenced below to electronically deposit my
payment to the account specified. This authority will remain in effect until I have filed a new authorization. I
understand that I can change my account or financial institution arrangement by completing a new Direct Deposit
form available from ConocoPhillips Owner Relations Unit.
Owner’s Signature
Date
Daytime Phone Number
FOURTH* –
EITHER A) ATTACH AN ORIGINAL VOIDED CHECK WITH THE NAME MATCHING THAT ENTERED AT
THE TOP OF THIS FORM, OR B) TAKE THIS FORM TO YOUR FINANCIAL INSTITUTION
If a voided check is not attached, or if depositing into a Savings Account, your financial institution’s “ACH”
direct deposit personnel must provide the information below and match it with the name and TIN or Social
Security Number (noted in #1above) to ensure no delay due to incorrect bank routing information.
Bank Routing (ABA) Number (9 digits):
Checking or Savings Account Number
.
Name of Financial Institution:
Bank Representative Name & Signature
Date
FIFTH* – Mail completed form to:
Telephone Number
ConocoPhillips Company
Attn: Owner Name & Address Dept. – 880 POB
P O Box 7500
Bartlesville, OK 74005-7500
Should you have any questions regarding direct deposit, please contact ConocoPhillips Owner Relations
Unit at one of the phone numbers reflected on your payment statement.
(Rev. 01-09)
DIRECT DEPOSIT
HOW WILL IT BENEFIT YOU?
Your payment will be placed in your financial institution account no later
than the morning of the day your check is currently mailed.
You do not have to go to your financial institution every month to
make your deposit.
Your payment cannot be lost or stolen, and it will be placed in your
account even if you are away from home or the office.
If an error is made in calculating your payment, we will NOT take funds
out of your financial institution account. Recoupments of overpayments
will be against future payments. If future payments are not available, we
will request payment.
Your payment can be direct deposited in most types of financial institutions
(i.e., banks, credit unions, and savings & loans). Your financial institution
will inform you if they are unable to accept direct deposit.
You will continue to receive your payment statement at your mailing
address.
And because you are a ConocoPhillips interest owner, this service will be
provided to you at NO COST.
(Rev. 01-09)