Form 637 Questionnaires

Applicant/Registrant Name:		EIN:	Period(s)
Agent Name:	Badge Number:			Date:
Form 637 Activity Letter “M” Questionnaire

Activity Letter M - Blender of gasoline, diesel fuel (including a diesel-water fuel emulsion), or kerosene, producing a taxable fuel outside the bulk transfer/terminal system, including blenders of alcohol fuel mixtures, biodiesel mixtures, and renewable diesel mixtures.

REGISTRATION TESTS – ACTIVITY “M”

1. The activity test of §48.4101-1(f)(2).

2. The acceptable risk test of §48.4101-1(f)(3).

3. The adequate security test of§48.4101-1(f)(4).

ACTIVITY TEST

1. List all locations and storage facilities where gasoline, diesel fuel, kerosene, or products used in blending are stored. List the expected annual volume (in gallons) of each product that will be sold or blended by each facility. Indicate with an (*) any facility that sells fuel at retail. (CEP and major oil companies may be exempted from this question.)

Name and Address of Storage Facility(ies)	Product Stored	Volume

2. List name and address of all fuel and blending component suppliers and list the type of product purchased (note with an asterisk those with which there will be tax-free transactions).

Name and Address of Supplier(s)	Product Purchased

3. Does the entity own fuel transports? If yes, list the VIN, GVW, and capacity of each. If no trucks are owned, how will be transported?

VIN	GVW	Capacity

4. Does the entity have a position in any terminal? If yes, list the name and location of terminal(s) and identify the product being stored.

Terminal’s Name and Location	Product(s) Stored

5. Does the entity own or operate any retail stations? If yes, list the locations below.

6. Is the entity blending biodiesel product?

7. If blending biodiesel product, is the entity using agri-biodiesel or biodiesel for blending?

8. Is the entity purchasing blended biodiesel product?

9. If the entity is purchasing agri-biodiesel or biodiesel, list the name and address of the entity’s supplier(s). Indicate agri-biodiesel and/or biodiesel.

Name and Address of Supplier(s)	Agri-biodiesel	Biodiesel

10. Does the entity have purchase contracts with the above supplier(s)? If yes, please have secure copy of contract(s).

11. Does the entity meet the activity test?

Acceptable Risk Test

1. Has the entity or a related person been penalized for a wrongful act? If so, explain. (For initial registrations, review the applicant’s responses to the questions listed in Part III, Section C, Page 2 of Form 637.)

Explanation:

2. Does the entity meet the acceptable risk test?

Adequate Security Test

Complete Form 637 Reengineering Forms: A620, B700,and B705

1. Does the entity have both adequate financial resources and a satisfactory tax history?

A620,B700, & B705

2. Does the entity meet the adequate security test?

A620,B700, & B705

	Form 637 Activity Letter “M” Questionnaire
	Workpaper # -1.0
	Rev. 3/2008