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Bidder Financial Form - United States Department Of The Interior Bureau Of Ocean Energy Management

United States Department of the Interior

Bureau of Ocean Energy Management

BIDDERS FINANCIAL FORM

The following information is provided relative to bids submitted for OCS Lease Sale Number:

Name of Company Submitting Bid(s):

BOEM Company Number:

Tax Identification Number:

General contact Person:

(Individual)

(Area Code – Phone Number(s))

(E-mail Address) Please use this email address to create the pay.gov account that will be used to submit your bid deposit, if you have

not already done so.

After the first time you set up your pay.gov account, BOEM will need to link your new account to the entity

on whose behalf you are bidding, a process which may take a few days. Until your account has been linked

to your entity, you will not be able to post a bid deposit to your company’s account. Please factor in this

additional time when setting up your account, in order to ensure that your bid deposit will be received

before the bid deposit deadline.

Send items by E-Mail or FED EX to the following addresses:

(Individual)

(Area Code – Phone Number(s))

(Street Address)

(City, State, Zip)

(E-mail Address)

II.

EFT payments will be coordinated by:

(Primary Individual)

(Phone)

(Fax)

(Alternate Individual)

(Phone)

(Fax)

III.

ACH refunds will be made to (Please do not use FedWire Information for Refunds):

(Name of Receiving Financial Organization)

(Recipient Account Number at Receiving Financial Organization)

(City and State of Receiving Financial Organization)

(Recipient Name in which Account is Maintained)

Note: The receiving financial organization must be a US Corporation.

(Nine-digit American Bankers Association Routing Number)

NOTE:

WE REQUEST THAT YOU PROVIDE THIS INFORMATION FOR EACH LEASE SALE IN THE FORMAT SUGGESTED ABOVE. PLEASE

PROVIDE THIS INFORMATION NO LATER THAN SEVEN CALENDAR DAYS AFTER PUBLICATION OF THE FINAL SALE NOTICE.

August 2012

Bidder Financial Form - United States Department Of The Interior Bureau Of Ocean Energy Management