Form 637 Questionnaires

Name:	EIN:
Address:	Registration No:
City, State, Zip

"C" QUESTIONNAIRE (Revision 02-01-2006)

Buyer of taxable tires for use on or in connection with the sale of another article the buyer manufactures and sells (1) for export, (2) to state and local governments, (3) to non-profit educational organizations, or (4) as supplies for vessels or aircraft.

Review Form 637, "Application for Registration" for any updates or changes. This includes Part I, II, and III. Attach the updates or changes to questionnaire. Notate if no updates or changes have been made since last visitation.

1. Who is responsible for the preparation and filing of Form 720 and/or Form 8849? From what address are they filed? ______________________________________________________________________________________________________________________________________________________________ _______________________________________________

2. Does the company, related company, or any of its owners incur any liability for excise tax? If so, name the type of tax. _________________________________________________________________________________________________________________________ _________________

3. Does the company sell or plan to sell any taxable articles to a related company? If so, describe the arrangements.

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ __________________

4. Has the company's excise, employment, or income tax returns been examined by the State or IRS during the previous five years? If so, what were the results of the examination?

_________________________________________________________________________________________________________________ ________________________

5. List the size and weight of the taxable tires that will be purchased excise tax-exempt.

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ____________

6. List the name and address of organizations or businesses with which you intend to have tax-exempt sales. _______________________________________________________________________________________________________________________________________________________________________________________________________________

7. List the name and address of the suppliers of taxable tires. ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

8. List the name and address of all locations where heavy tires are sold at retail?

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

9. Provide the name and address of any brokers used to export tires subject to excise tax. ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

10. Please describe the proof of export the company plans to obtain to verify the articles were actually exported. ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________