Form 637 Questionnaires

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

"D" QUESTIONNAIRE (Revision 02-01-2006

Buyer with a place of business in the United States purchasing vaccines, gas guzzler automobiles, taxable tires, sport fishing equipment (including fishing rods and fishing poles), fishing tackle boxes, bows, quivers, broadheads, points, or arrow shafts for export or for resale to a second purchaser for export.

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.

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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?

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5. List the name and address of suppliers and the applicable items purchased for export or for resale to a second purchaser for export. ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

6. List the name, address, and 637 registration number of all purchasers, or second purchasers to whom the company intends to sell articles for export. ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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

8. Provide the name and address of any brokers used to export products subject to excise tax.

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