Application for LSAS Client ID by pptfiles

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									                                                                                Revised February 24, 2009




                        Application for LSAS Client ID


Client Registry, Client Services                                    Date:
Alberta Department of Energy
3rd Floor, North Petroleum Plaza
9945 – 108 Street
Edmonton, Alberta
T5K 2G6
Fax (780) 422-9522


Re: Request for LSAS Client ID for application of surface dispositions on Public Lands.

Individual’s Name:                                                          (please print)


         or

Company Name:                                                               (please print)




Address:




Phone:           (     )

FAX: (optional) (      )

Signature:       ____________________________

Print Name: ___________________________

Note:

             Company name must be registered under Business Corporation Act
             Individuals name must be the legal name
             No trade names

								
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