Direct Deposit Authorization Form

First Name* Middle Name Last Name* Address Line 1* Address Line 2 City* State* Zip Code* Depository Bank Name* Account Number* ABA Routing Number* Account Type Upload voided check image*

**Please remember to attach a voided check to this form for all accounts authorized. Payee agrees to give BCE-Mach LLC thirty (30) days advance written notice of any change in the payment instructions above. By signing below, payee hereby agrees to the terms enumerated herein, certifies that the depository information listed on this form is true and accurate and authorizes BCE-Mach LLC to issue payments to payee electronically. Signature* (Type Full Name)

Revenue Owners: For any additional information or assistance, please contact Division Orders at

Telephone:

(405) 252-8197

Email:

ownerrelations@machresources.com

Address:

BCE-Mach LLC

Attn: Division Orders

PO BOX 21880

Oklahoma City, OK 73156

Mach Resources Owner Relations

Direct Deposit Authorization Form