Lets get Fracking!!! Dry Frac Intake Form Dry Frac Intake Form To get started with re-fracking your wells, please provide as much information about your wells as possible. The more information you provide, the better we can assist you. If you have any questions or need assistance please call us at Contact Information Name * Name First First Last Last Phone * Email * Address * Address Address Address City City State/Province State Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal How many Wells do you have? * What County(s) are your wells located? What is the timeframe for needing or wanting a DryFrac with no permits required for the frack material or installation crew? Do you have a wireline vendor at the ready to install the equipment? Do you have a crew to remove completion equipment during the frack process and reinstall it afterward? Enter Well #1 Details Well #1 ID or Name Well #1 State and County Location Well #1 Vertical or Horizontal VerticalHorizontal Well #1 Bore Diameter Well #1 Depth Well #1 Pay Zone Length Downhole Well #1 Fracked? YesNo Well #1 Previous Frack Method Well #1 Current Flow Rate Well #1 Peak Historical Flow Rate Well #1 Duration of Benefits Well #1 HAZMAT Management & Removal Costs Enter Additional Well(s) Details Well ID or Name Well State and County Location Well Vertical or Horizontal VerticalHorizontal Well Bore Diameter Well Depth Well Pay Zone Length Downhole Well Fracked? YesNo Well Previous Frack Method Well Current Flow Rate Well Peak Historical Flow Rate Well Duration of Benefits Well HAZMAT Management & Removal Costs Add Wells Remove Wells I authorize DryFrac to contact me regarding the information submitted. * Yes, I agree to DryFrac's Terms and Conditions and may contact me via phone, text, or email. If you are human, leave this field blank. Submit
