Form 637 Questionnaires

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

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

Credit card issuer that issues credit cards for sales of taxable fuel to a state or local government for its exclusive use or for sales of gasoline to a nonprofit educational organization or its exclusive use.

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 8849 or Form 4136? 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. 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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4. List the name and address of all the company's suppliers of gasoline and diesel fuel.

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5. Does the company store any gasoline or diesel fuel to which it does not hold title? If so, where is this inventory stored? For whom is it stored? Are separate inventory records maintained?

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5. List all locations and storage facilities where gasoline and diesel fuel is stored that will sell undyed diesel fuel to state/local governments, non-profit educational organization. List the expected volume (in gallons) of undyed gasoline /diesel fuel sold to these entities. Attach additional sheets if needed.

Name of Facility	Address of Facility	Capacity of Gasoline / Diesel Fuel Tank(s)	Expected Annual Volume

Indicate with an (*) any facility where dyed diesel fuel is sold.

5. Are you or your customers reimbursed for the federal excise tax on diesel fuel for any credit card sales? If so, explain.

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8. What are your procedures for securing exemption certificates from customers who purchase without the federal excise tax?

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8. Does the company store any fuel to which it does not hold title? If so, where is this inventory stored? For whom is it stored? Are separate inventory records maintained? Who is filing claims for these sales to state/local government, nonprofit educational organization, and farmers for farming purposes?

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8. Do you sell undyed diesel fuel and/or kerosene on consignment? If so, where is this inventory stored? For whom is it stored? Are separate inventory records maintained? Who is filing claims for these sales to state/local government, nonprofit educational organization, and farmers for farming purposes?

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