Direct Deposit Request

Rice Energy Direct Deposit Form



Please complete all information in the form below to set up direct deposit with Rice Energy and return completed form with your voided check. If all required information is not filled in or a voided check is not attached, your request cannot be processed. For questions, please contact the Rice Energy Community and Land Owner Hotline at 855-258-8326.

 
First Name
Middle Name
Last Name
Street Address
City
State
Zip Code
Phone Number
Email Address
***Email Address is required if you wish to receive your royalty receipt by Email
Owner Number
Bank Account Number
Routing Number
Last 4 of SSN
Royalty Statement Receipt Preference

Attach Voided Check

With my signature below, I confirm that I am a revenue interest owner or an authorized representative and have the requisite authority to agree to the terms and conditions herein. I agree that Rice Energy Inc. and its subsidiaries (including Rice Drilling B, Rice Drilling D and Bates Colonel Operating Co. LLC), affiliates, agents, and authorized representatives, (collectively “Rice”) ·assumes no responsibility for any loss initiated by errors, omissions or delays caused by me or my depository bank. Rice assumes no responsibility for fees or deductions made by my depository bank. I agree to hold Rice harm less and indemnify Rice from and against all liabilities, claims, losses, costs, expenses and damages of any kind including direct/indirect, consequential and punitive asserted against Rice directly or indirectly from or arising out of the electronic transfer of funds contemplated by this enrollment form. I hereby authorize and request Rice to make payments via electronic transfer into the referenced account and if selected on this form, to have statement notifications be electronically emailed to the email address provided in lieu of standard mail. This authorization shall remain in force until Rice has received written authorization from the undersigned of its termination and Rice has had reasonable time to effect such termination. Rice is further granted the right to correct any electronic fund transfers resulting from any erroneous overpayment by withholding the overpaid amount from future electronic transfers. I also agree that I am responsible for alerting Rice of any account changes or closures that would interfere with any electronic fund transfers and do not hold them responsible for any delays or fees that may incur from my failure to provide necessary changes or information. I understand I should also contact my bank to verify receipt of funds.
I have read and Agree to the terms and conditions

Initials