Carrier Summary Report

Form

720-CS

(Rev. September 2010)
Department of the Treasury
Internal Revenue Service

Part I

Carrier Summary Report
For the month ending

, 20

OMB No. 1545-1733

.

Corrected

Void

Carrier

Company name

Employer identification number (EIN)

Address (number, street, room or suite number)

Form 637 registration number

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City, state, and ZIP code (Foreign addresses, include province and postal code as appropriate. Do not abbreviate country name.)

Contact person

Part II

Daytime telephone number

Transactions for the Month

Fax number

Email address

Net Gallons (attach additional schedule(s) if needed)

Enter the transactions for the period on Schedules A and B, then complete
lines 1 and 2 for each product code (PC) (see instructions).

(a)

PC:
1

Total receipts. Enter the total net gallons from
Schedule(s) A, column (g), by PC. If you have
receipts from more than one facility for a PC,
add the amounts from each facility's Schedule
A and enter the combined total by PC.

2

Total deliveries. Enter the total net gallons
from Schedule(s) B, column (g), by PC. If you
have deliveries to more than one facility for a
PC, you must add the amounts from each
facility’s Schedule B and enter the combined
total by PC.

(b)

PC:

(c)

PC:

(d)

PC:

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my
knowledge and belief, it is true, correct, and complete.
Signature a

Title, if applicable a

Date a

Type or print your name below signature.
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.

Cat. No. 73073H

Form 720-CS (Rev. 9-2010)

Carrier Receipts

EIN

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(b)
Consignor
name

(c)
Mode
code

of

FCN of facility

(d)
Vessel official number
(required when mode
code is B, S, IB, IS, EB, or ES)
(e)
Document
date

(f)
Document
number

Void

Page 2

3

(g)
Net
gallons

Form 720-CS (Rev. 9-2010)

last page of Schedule A for that PC. Do not enter page subtotals. Enter the amount from column (g) on Form 720-CS, Part II, line 1, in the column for the
applicable PC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . a

3 Total. Add all amounts in column (g) and enter the total. If there is more than one page for a PC, add the amounts from each page and enter the result on the

(a)
Consignor
EIN

Page

Corrected
For the month ending (enter MM/DD/YYYY)

For more than one Schedule A, for each different PC, number each sheet. For
example, 1 of 4, 2 of 4, etc.

Form 637 registration number

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2 Enter in the columns below the information requested for the PC on line 1 above.

required for each PC

1 Product Code (PC). Enter the PC (see instructions). A separate schedule is

Facility name. Complete a separate Schedule A for each facility.

Schedule A

Carrier name as shown on Form 720-CS

Form 720-CS (Rev. 9-2010)

Carrier Deliveries

EIN

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a

(b)
Consignor
name

(c)
Mode
code

of

(d)
Vessel official number
(required when mode
code is B, S, IB, IS, EB, or ES)
(e)
Document
date

the last page of Schedule B for that PC. Do not enter page subtotals. Enter the amount from column (g) on Form 720-CS, Part II, line 2, in the column for
the applicable PC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(g)
Net
gallons

3
Form 720-CS (Rev. 9-2010)
a

(f)
Document
number

For more than one Schedule B, for each different PC, number each sheet. For
example, 1 of 4, 2 of 4, etc.

FCN of facility

Page 3
Corrected
Void
For the month ending (enter MM/DD/YYYY)

3 Total. Add amounts in column (g) and enter the total. If there is more than one page for a PC, add the amounts from each page and enter the result on

(a)
Consignor
EIN

2 Enter in the columns below the information requested for the PC on line 1 above.

.

1 Product Code (PC). Enter the PC (see instructions). A separate schedule is

required for each PC

Page

Form 637 registration number

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Facility name. Complete a separate Schedule B for each facility.

Schedule B

Carrier name as shown on Form 720-CS

Form 720-CS (Rev. 9-2010)