Landowner Surface Use Agreement

This Surface Use Agreement ("Agreement") is entered into on this day of , , by and between:

1. Parties

2. Property Description

3. Purpose

4. Term

5. Payment

6. Landowner Rights and Restrictions

7. Reclamation & Restoration

8. Access

9. Insurance & Liability

10. Miscellaneous

Landowner Signature Date
Operator/Company Signature Date