Taxable Fuel: 637 Registration Program

Application for Registration (for Certain Excise Tax Activities) and Questionnaires

Questionnaires

Taxable Fuel: 637 Registration Program

OMB: 1545-1835

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1545-1835 can be found here:

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Name:
Address:
City, State, Zip

EIN:
Registration No:

"A" QUESTIONNAIRE

(Revision 02-01-2006)

Manufacturer of gas guzzler automobiles, sport fishing equipment (including
fishing rods and fishing poles), fishing tackle boxes, bows, quivers, broadheads,
points, arrow shafts, taxable tires, or vaccines.
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 all articles manufactured and explain the company’s manufacturing process.
Enclose advertising brochures, if available.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

6. List the name and address of organizations or businesses to which you sell or will
sell articles tax-free.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
7. List the monthly volume of tax-free articles you intend to sell. Also list the monthly
volume of taxed articles you intend to sell.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
8. Do you export? Are you the exporter, or do you sell to a buyer for subsequent
export? What records are maintained to verify that the products are subsequently
exported?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
9. List your primary competitors.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

TIN:

DATE:

Name:
Address:
City, State, Zip

EIN:
Registration No:

"AB" QUESTIONNAIRE (Revision 02-01-2006)
Producers and importers of agri-biodiesel. Agri-biodiesel is the fuel made from virgin vegetable
oils and animal fats.

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. Does the company sell or plan to sell any agri-biodiesel fuel 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 name and address of all the company's suppliers of agri-biodiesel fuel.
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

TIN -

DATE -

6. Does the company store any agri-biodiesel 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?
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
7. List all locations and storage facilities where agri-biodiesel fuel is stored. List the
expected volume (in gallons) of agri-biodiesel fuel sold to these entities. Attach
additional sheets if needed. (CEP and major oil companies may be exempted from
this question.)
Name of Facility

Address of Facility

Capacity of the
Agri-Biodiesel
Fuel Tank(s)

Expected
Annual Volume

8. Please list the types of agri-biodiesel being produce and imported.
__________% Agri-biodiesel (derived solely from virgin oils, including esters
derived from virgin vegetable oils from corn, soybeans, sunflower seeds,
cottonseeds, canola, crambe, rapeseeds, safflowers, flaxseeds, rice bran, and
mustard seeds and from animal fats.
9. Is the agri-biodiesel produced or imported by you a pure fuel or is it blended with
petroleum diesel? If yes, please list the percentage of blend.
__________ % by volume agri-biodiesel.
__________ % by volume petroleum diesel
10. Please list all production agreements with agri-biodiesel marketing firms that you
plan on implementing with the year.

TIN -

DATE -

11. Are you or your customers reimbursed for the federal excise tax on agri-biodiesel
fuel for any credit card sales? If so, explain.
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
12. What are your procedures for securing exemption certificates from customers who
purchase without the federal excise tax?
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
13. List the names and addresses of all customers that you have sold or plan to sell agribiodiesel without the federal excise tax? Indicate with an * any customer who
purchases in bulk quantities.

_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
14. Do you sell agri-biodiesel as a distributor?

_____________________________________________________________________
15. Does the company store any agri-biodiesel 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 the production or importation of the
fuel?

_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
17. Do you export or plan to export any agri-biodiesel fuel product?

TIN -

DATE -

TIN -

DATE -

Name:
Address:
City, State, Zip

EIN:
Registration No:

"AF" QUESTIONNAIRE

(Revision 02-01-2006)

Producers and importers of alcohol. Alcohol has the meaning given to the term in
§ 48.4081-6(b)(1) except that, for purposes of the credit allowed by § 40, alcohol also
includes alcohol with a proof of at least 150.
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. Does the company sell or plan to sell any alcohol fuel 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. Does the company store any alcohol or 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?
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

TIN -

DATE -

6. List all locations and storage facilities where gasoline, gasohol, or alcohol is stored.
List the expected volume (in gallons) of each product that will be sold or blended by
each facility. Attach additional sheets if needed. (CEP and major oil companies may
be exempted from this question.)
Name of Facility

Address of Facility

Tank #

Product
Stored

Expected
Annual
Volume

Indicate with an (*) any facility that sells fuel at retail.
7. Does the company store product to which it does not hold title? If so, what type of
product, who owns the product, and where is it stored?
___________________________________________________________________
___________________________________________________________________
8. Does the company consign for alcohol or fuel? If so, list the name, address, and
relationship to those entities.
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
9. Does the company own transports? If so, how many and what is the capacity of
each truck?
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
10. Does the company use common carriers to transport fuel? If so, please provide the
names and addresses of the common carriers.
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

TIN -

DATE -

11. Do you make any tax-exempt sales? If so, to whom?
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
12. Are you registered, licensed, or permitted by any state or local authorities? If so,
provide agencies and license numbers.
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
13. What are the estimated annual gallons of alcohol imported from another country?
_________________________________________________________________
14. What are the estimated annual gallons of alcohol fuel produced in the United States?

15. List the type & proof, monthly gallons, and percentage of alcohol purchased used in
the production of gasohol.
Type & Proof
of Alcohol

Monthly Gallons
Purchased

Percentage used in the
Production of Gasohol

16. List the name and address of company's suppliers of alcohol.
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
17. Estimate your annual number of gallons produced for each type of gasohol:
10% Gasohol ________________
7.7% Gasohol ________________
5.7% Gasohol ________________

17. List the monthly volume of alcohol purchased for gasohol production.
___________________________________________________________________
18. List the name and address of all suppliers of alcohol fuel mixture List any of the
above suppliers that will not sell gasoline at a reduced rate for gasohol production.
___________________________________________________________________

TIN -

DATE -

19. Describe the process used to produce alcohol.
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
20. What steps does the company have in place when gasoline purchased at a taxreduced rate is not used in the production of gasohol or other alcohol fuel mixtures?
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

Overview. Effective January 1, 2005, the Act generally eliminates the reduced rate of excise tax for most alcoholblended fuels. In place of a reduced rate, the Act allows certain credits or payments related to alcohol and biodiesel
fuels under §§ 40, 40A, 6426, and 6427(e). If the alcohol is ethanol with a proof of 190 or greater, the credit or
payment amount is $0.51 per gallon. For agri-biodiesel, the credit or payment amount is $1.00 per gallon; for biodiesel
other than agri-biodiesel, the credit or payment amount is $0.50 per gallon. Under the Code’s coordination rules, a
claim may be taken only once with respect to any particular gallon of alcohol or biodiesel
Excise tax credit for alcohol fuel and biodiesel mixtures; § 6426. Section 6426 allows a credit against the tax imposed
by § 4081 on taxable fuel. The credit is equal to the sum of the alcohol fuel mixture credit and the biodiesel mixture
credit. The credit is allowable to the person that produces the mixture for sale or use in the producer’s trade or
business. The credit is claimed on Form 720, Quarterly Federal Excise Tax Return, in accordance with the
instructions for that form.
Income tax credits or payments for alcohol or biodiesel used to produce alcohol fuel and biodiesel mixtures; §§ 34 and
6427(e)—(1) In general. To the extent that the sum of the alcohol fuel mixture credit and biodiesel mixture credit
described in § 6426 exceeds a person’s § 4081 liability for any particular quarter, an income tax credit or a payment
under § 6427(e) is allowable to the producer of the mixture. This credit or payment is claimed on Form 720, Quarterly
Federal Excise Tax Return; Form 4136, Credit for Federal Tax Paid on Fuels; or Form 8849, Claim for Refund of
Excise Taxes; in accordance with the instructions for those forms.

TIN -

DATE -

Name:
Address:
City, State, Zip

EIN:
Registration No:

"B" QUESTIONNAIRE (Revision 02-01-2005)
Buyer of sport fishing equipment (including fishing rods and fishing poles), fishing
tackle boxes, gas guzzler automobiles, bows, quivers, broadheads, points, or
vaccines for further manufacture or for resale to a buyer for further manufacture.

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 all articles purchased for further manufacture or resale to a buyer for further
manufacture and explain the company’s manufacturing process Enclose
advertising brochures, if available.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

6. List the name and address of organizations or businesses from which you will
purchase tax-free articles for further manufacture.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
7. List the name and address of organizations or businesses to which you sell tax-free
articles.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
8. Are you purchasing raw materials or taxable items for further manufacturing or for
resale to a buyer for further manufacture? If so, what materials?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
9. Do you buy articles for export? What records are maintained to verify that the
products are subsequently exported?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
10. List your primary competitors.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

TIN:

DATE:

Name:
Address:
City, State, Zip

EIN:
Registration No:

"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 taxexempt.
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
____________________________________________________
____________

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.
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
__________________________________________________________________

TIN:

DATE:

Name:
Address:
City, State, Zip

EIN:
Registration No:

"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?

_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
4. List the name and address of all the company's suppliers of gasoline and diesel fuel.

_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
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?

TIN -

DATE -

6. 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.
Expected
Name of Facility
Address of Facility Capacity of Gasoline /
Diesel Fuel Tank(s)
Annual Volume

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

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

_____________________________________________________________________
_____________________________________________________________________

9. 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?

_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

TIN -

DATE -

10. 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?

_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

TIN -

DATE -

TIN -

DATE -

Name:
Address:
City, State, Zip

"D" QUESTIONNAIRE

EIN:
Registration No:

(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.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
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 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.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

TIN:

DATE:

Name:
Address:
City, State, Zip

EIN:
Registration No:

“E” QUESTIONNAIRE (Revision 02-01-2006)
Buyer (other than state or local government) of gas guzzler automobiles for ambulance,
law enforcement, or firefighting.
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 gas guzzler automobiles 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 make, model, GVW, and fuel economy rating of the gas-guzzler automobiles
that you will be buying for use and used as an ambulance, in law enforcement, or in
fire fighting.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

TIN -

DATE -

6. List the name, and address of your suppliers of gas-guzzler automobiles purchased for
use and used as an ambulance, in law enforcement, or in fire fighting.

___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________

TIN -

DATE -

Name:
Address:
City, State, Zip

EIN:
Registration No:

“F” QUESTIONNAIRE (Revision 02-01-2006)
Nonprofit educational organization, other than a public school, buying taxable
tires, certain heavy vehicles, sport fishing equipment (including fishing rods and
fishing poles), fishing tackle boxes, bows, quivers, broadheads, points or arrow
shafts for 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 720 and/or Form 8849?
From what address are they filed?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
2. Does the organization, related company, or any of its board members incur any
liability for excise tax? If so, explain and name the type of tax.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
3. Has the State or IRS examined the non-profit organization during the previous five
years? If so, what were the results of the examination?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
4. Provide a general description of the type of educational facility, including faculty,
curriculum, and student body. Include brochures, if available. Also provide a
copy of your tax-exempt determination letter.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

TIN -

DATE -

5. Describe how the products will be used in the operation of the organization.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
6. List activities (other than educational) conducted by the organization.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
7. Will you store any motor fuel? If so, provide the location, capacity, and type of
fuel stored in all tanks.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
8. List all vehicles that you operate. Provide the year, make, model, type of fuel
used, and number and type of tires used by each vehicle.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
9. List the name, and address of your suppliers that sell you federal excise tax free
products. List the type of products that purchase from each of these suppliers.
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
10. Do you resell any products that you bought tax-free? If so, to whom?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

TIN -

DATE -

Name
Address
City, State, Zip

EIN:
Registration No

"I" QUESTIONNAIRE (Revision 02-01-2006)
Buyer (other than nonprofit educational organization or state or local
government) of taxable tires for use on certain intercity, local, or school buses.
Definitions—(1) Intercity bus transportation—(i) In general. An automobile bus is
engaged in intercity bus transportation if it is engaged in the furnishing (for
compensation) of passenger land transportation available to the general public
and the bus is engaged in- (A) Scheduled transportation along regular routes; or
(B) Nonscheduled transportation if the seating capacity of the bus is at least 20
adults (not including the driver).
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? 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 tires 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?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

TIN -

DATE -

5. Furnish the following information for all vehicles used by your company:
Model

Year

License Plate #

Seating
Capacity

Tire
Size

6. What is the estimated number of tires purchased annually?
_____________________________________________________________________
_____________________________________________________________________
7. List the name and address of all your tire suppliers.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
8. Does the company provide transportation for public or private schools? If yes,
provide a list of the schools or school systems for which the company provides
transportation and a copy of each contract.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
9. Does the company provide regularly scheduled intercity or local bus transportation?
If yes, provide the route schedules.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

TIN -

DATE -

TIN -

DATE -

Name:
Address:
City, State, Zip

EIN:
Registration No:

"K" QUESTIONNAIRE (Revision 02-01-2006)
Buyer of kerosene for a feedstock purpose.
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 kerosene 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?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
6. List all products containing kerosene that your company manufactures.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

TIN -

DATE -

7. Is kerosene used in any other manner beside the manufacture of these products? If
so, describe.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

8. List all locations and storage facilities where kerosene is stored. List the expected
volume (in gallons) of kerosene to be used by each facility. Attach additional sheets
if needed.
Name of Facility

Address of Facility

Capacity of
Kerosene Tank(s)

Expected
Annual Volume

9. List name and address of all current and anticipated suppliers of kerosene.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
10. List approximate annual quantity of kerosene purchased.
_____________________________________________________________________
_____________________________________________________________________

TIN -

DATE -

Name:
Address:
City, State, Zip

EIN:
Registration No:

"M" QUESTIONNAIRE (Revision 02-01-2006)
Blender of gasoline, diesel fuel (including diesel-water emulsions) or kerosene
outside the bulk transfer/terminal system, including blenders of alcohol fuel
mixtures, and renewable diesel mixtures.
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 fuel 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. Does the company store any fuel to which it does not hold title? If so, where is this
inventory stored? For who is, it stored? Are separate inventory records maintained?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

TIN -

DATE -

6. List all locations and storage facilities where gasoline, diesel fuel, kerosene, or
products used in blending are stored. List the expected volume (in gallons) of each
product that will be sold or blended by each facility. Attach additional sheets if
needed. (CEP and major oil companies may be exempted from this question.)
Name of Facility

Address of Facility

Tank #

Product Stored

Expected
Annual
Volume

Indicate with an (*) any facility that sells fuel at retail.
7. Does the company own fuel transports? If yes, list the VIN, GVW, and capacity of
each.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
8. If no trucks are owned, how will the fuel be transported?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
9. List the additives and products that will be used for blending with gasoline, diesel
fuel, or kerosene.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
10. List the estimated annual volume of additives and products that you will buy.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

TIN -

DATE -

11. List the estimated annual volume of blended fuel that you will produce.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
12. 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).
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
13. List the name and address of customers (note type of fuel and asterisk those with
which there will be tax-free transactions).
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
14. List approximate annual disposals in gallons for each type of product:
Regular unleaded gasoline:_______________________________
Midgrade unleaded gasoline:_____________________________
Premium unleaded gasoline:______________________________
Oxygenated gasoline:___________________________________
Diesel Fuel- High Sulphur:_______________________________
Diesel Fuel-Low Sulfur-Dyed:____________________________
Diesel Fuel-Low Sulfur-Clear:____________________________
Aviation Gasoline:_____________________________________
Jet Fuel:______________________________________________
Kerosene:____________________________________________
Blend Stocks:_________________________________________
Additives:____________________________________________
15. Are you blending product or are you purchasing blended biodiesel product?

16. If you are blending product, are you blending using agri-biodiesel or biodiesel?
_____________________________________________________________________

TIN -

DATE -

17. If you are blending, list suppliers of agri-biodiesel and biodiesel that will be
Blended with diesel fuel and which product will be purchased from suppliers.
Supplier Name

18. Do you have purchase contracts with the above suppliers? If yes, please have
copies available.
19. Where will the above products be picked up?
Suppliers Name

20. If you are not blending, who are you purchasing the blended product from?

Suppliers Name

| Suppliers Address

Annual gallons purchased *
Agri-biodiesel | Biodiesel

* If new applicant, anticipated annual gallons purchased

21. Do you own or operate any retail stations? If yes, list locations below.

22. Do you have a position in any terminal? If yes, list locations.
23. Whom do you intend to supply with this biodiesel? Do you have any contracts to
supply this product?

TIN -

DATE -

Name:
Address:
City, State, Zip

EIN:
Registration No:

"NB" QUESTIONNAIRE (Revision 02-01-2006)
Producers and importers of biodiesel (other than agri-biodiesel), including renewable diesel. Biodiesel is the fuels made from recycle oils. Renewable diesel is any organic material other than (1)
oil and natural gas (or any product thereof or (2) coal, including lignite (or any product thereof).
The Energy Bill mentions the term “offal” in describing renewable diesel. Offal is defined as waste
parts, especially from butchered animals

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. Does the company sell or plan to sell any biodiesel fuel 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 name and address of all the company's suppliers of biodiesel fuel.
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

TIN -

DATE -

6. Does the company store any biodiesel 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?
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
7. List all locations and storage facilities where biodiesel fuel is stored. List the
expected volume (in gallons) of biodiesel fuel sold to these entities. Attach additional
sheets if needed. (CEP and major oil companies may be exempted from this
question.)
Name of Facility

Address of Facility

Capacity of Biodiesel
Fuel Tank(s)

Expected
Annual Volume

8. Please list the types of biodiesel being produce and imported.
__________% Biodiesel (other than agri-biodiesel) recycle oils.
9. Is the biodiesel produced or imported by you a pure fuel or is it blended with
petroleum diesel? If yes, please list the percentage of blend.
__________ % by volume biodiesel.
__________ % by volume petroleum diesel
10. Please list all production agreements with biodiesel marketing firms that you plan on
implementing with the year.

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

TIN -

DATE -

___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
12. What are your procedures for securing exemption certificates from customers who
purchase without the federal excise tax?
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
13. List the names and addresses of all customers that you have sold or plan to sell
biodiesel without the federal excise tax? Indicate with an * any customer who
purchases in bulk quantities.

_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
14. Do you sell biodiesel as a distributor?

_____________________________________________________________________
15. Does the company store any biodiesel 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 the production or importation of the
fuel?

_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
17. Do you export or plan to export any biodiesel fuel product?

TIN -

DATE -

TIN -

DATE -

Name:
Address:
City, State, Zip

EIN:
Registration No:

“Q” QUESTIONNAIRE (02-01-2006)
First retailer seller od certain heavy vehicles..
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.
Document any updates or changes since last visitation.
1. Who prepares Form 720 and/or Form 8849?
______________________________________________________________
______________________________________________________________
______________________________________________________________
2. Do you have any related companies or owners who incur any excise tax? If
so, name the company, owner, their TIN, and the type of tax they report.
______________________________________________________________
______________________________________________________________
______________________________________________________________

3. Do you sell or plan to sell any taxable articles to a related company? If so,
explain.
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
4. Has your 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. Who are your suppliers of trucks, truck bodies, incomplete chassis, trailers,
trailer bodies, or semi-tractors? (name, address, telephone number, and
contact person)
________________________________________________________________

TIN -

DATE -

6. Do you mount truck bodies to a chassis for a customer when the customer
provides either component? If so, how do you account for the federal excise
tax?
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
7. Do you modify trailers or truck chassis (including adding axles) for
customers? If so, how does the company determine if it is a taxable event?
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
8. How do you account for any subsequent work performed on the vehicle either
in-house or by subcontractors within 6 months of the first retail sale? If so,
how?
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
9. Do you or any subsidiaries lease heavy trucks, tractors, or trailers? If so, are
they to related parties?
______________________________________________________________
______________________________________________________________
10. Do you import or export any new or used trucks, tractors, trailers, bodies, or
chassis? If so, explain and provide any export documents.
______________________________________________________________
______________________________________________________________
______________________________________________________________
11. Do sell additional tires as parts or accessories? If so, are the tires imported?
______________________________________________________________
______________________________________________________________
12. How does the company calculate the retail sales price of units subject to
federal excise tax (including tire credit)? If company uses a worksheet, attach
a blank copy to show the method used. (Valuation of trade-ins, installment
sales, etc.). Who computes the FET on any sale?
______________________________________________________________
______________________________________________________________
______________________________________________________________
___________________________________________________________

TIN -

DATE -

13. Do you make tax-free sales?
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
____________________________
14. Do you secure exemption certificates for these tax-free sales? If not, explain.
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
____________________________
15. Do you sell vehicles on consignment? If so, how is the federal excise tax
determined?
______________________________________________________________
______________________________________________________________
______________________________________________________________
_____________________
16. Do you purchase trucks, tractors, trailers, bodies, or chassis for your own
use? If so, is the company paying federal excise tax on the taxable vehicles?
______________________________________________________________
______________________________________________________________
______________________________________________________________
_____________________

TIN -

DATE -

Name:
Address:
City, State, Zip

EIN:
Registration No:

"S" QUESTIONNAIRE

(Revision 02-01-2006)

Enterer, position holder, refiner, terminal operator, or throughputter of gasoline,
diesel fuel (including diesel-water fuel emulsions), or kerosene, or industrial user
of gasoline.
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 fuel 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. Name all carriers, except for trucks, that are used to receive or dispose of fuel.
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
TIN -

DATE -

6. List all locations and storage facilities where gasoline, diesel fuel, kerosene,
blend stocks (e.g. 87 octane, # 3 diesel, undyed # 2 diesel, type of blend
stocks, etc) are stored. List the expected volume (in gallons) of each product
that will be sold or blended by each facility. Attach additional sheets if needed.
(CEP and major oil companies may be exempted from this question.)
Name of Facility

Address of Facility

Tank #

Product
Stored

Expected
Annual
Volume

Indicate with an (*) any facility that sells fuel at retail.
7. Check the box (es) representing activities in which you are engaged.
Activity
Refiner
Importer/Enterer
Terminal Operator
Throughputter
Industrial User
Positionholder
Exporter

Gasoline

Diesel Fuel

Kerosene

Other

8. Check the box (es) representing all means by which you receive or dispose of
fuel.
Means

Receipts

Disposals

Barge
Pipeline
Rail
Truck
Ocean Going Vessel
In-Tank Transfers
Exchange
Agreements

TIN -

DATE -

9. Do you export or plan to export any taxable fuel product? If so, indicate those
products.
______________________________________________________________
______________________________________________________________
______________________________________________________________
10. Do you import or enter or plan to import or enter any taxable fuel product? If
so, indicate those products.
______________________________________________________________
______________________________________________________________
______________________________________________________________
11. List the name and addresses of anyone that will be acting for you as an agent
or broker in entering, buying, selling, or transporting any fuel.
______________________________________________________________
______________________________________________________________
______________________________________________________________
12. List the name and address of your fuel-related suppliers, and indicate the type
of products purchased from each. Indicate with an asterisk (*) any supplier
with whom you will not or have not conducted tax-free transactions.
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
13. List the names, addresses and 637 Numbers of all of your fuel-related
customers with whom you will conduct tax-free transactions. (CEP or major oil
companies may be exempted from this question.
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
14. Does the company store product to which it doesn't hold title? If so, what type
of product, who owns the product, and where is it stored?
______________________________________________________________
______________________________________________________________
______________________________________________________________
15. Does the company consign fuel? If so, list the name, address, and
relationship to those entities.
______________________________________________________________
______________________________________________________________
______________________________________________________________

TIN -

DATE -

16. Does the company own transports? If so, how many and what is the capacity
of each truck?
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
17. List the bank(s) used as depositary agents for excise taxes.
______________________________________________________________
______________________________________________________________

TIN -

DATE -

Refiners
1. List the name and address of the pipeline operators, barge companies, and/or
ocean-going vessel operators that supplies your crude oil.
______________________________________________________________
______________________________________________________________
______________________________________________________________
2. Indicate the products the company produces. (e.g. 87 octane, # 3 diesel, types
of blend stock, etc).
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
3. What does the company do with transmix?
______________________________________________________________
______________________________________________________________
______________________________________________________________
4. Indicate how the transmix is received. Provide the name and address of the
carrier(s) if not listed above.
______________________________________________________________
5. What is the production capacity per day per product?
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
6. Provide a schematic of each refinery the company operates.

TIN -

DATE -

Importer/Enterer
1. From what countries is product imported?
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________

2. What are the ports of entry?
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________

3. What carriers do you use for imported product?
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________

4. List the name and address of suppliers and the type of product imported.
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________

TIN -

DATE -

Terminal Operator
1. Provide the name, address, and telephone number of all terminal
managers.
___________________________________________________________
___________________________________________________________
2. List all modes of transport used to receive fuel.
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
3. Provide your average monthly turnover of each product.
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
m.
n.
o.

Regular Unleaded Gasoline _____________________________________
Mid-grade Unleaded Gasoline ___________________________________
Premium Unleaded Gasoline ____________________________________
Oxygenated Gasoline __________________________________________
Gasohol ____________________________________________________
Racing Gasoline ______________________________________________
Diesel Fuel - High Sulfur _______________________________________
Diesel Fuel - Low Sulfur - Dyed __________________________________
Diesel Fuel - Low Sulfur - Clear __________________________________
Aviation Gasoline _____________________________________________
Jet Fuel _____________________________________________________
Kerosene - Clear _____________________________________________
Kerosene - Dyed _____________________________________________
Blend Stocks ________________________________________________
Additives ___________________________________________________

4. Does the company hold a position in any of the product in the terminal(s)?
If so, list the ending inventory for each product as of the end of the previous
month.
Regular Unleaded Gasoline _____________________________________
Mid-grade Unleaded Gasoline ___________________________________
Premium Unleaded Gasoline ____________________________________
Oxygenated Gasoline __________________________________________
Gasohol ____________________________________________________
Racing Gasoline ______________________________________________
Diesel Fuel - High Sulfur _______________________________________
Diesel Fuel - Low Sulfur - Dyed __________________________________
Diesel Fuel - Low Sulfur - Clear __________________________________
Aviation Gasoline _____________________________________________
Jet Fuel _____________________________________________________
Kerosene - Clear _____________________________________________
Kerosene - Dyed _____________________________________________
Blend Stocks ________________________________________________
TIN -

DATE -

Additives ___________________________________________________

5. If diesel fuel is dyed at the terminal, describe your dye injection system.
___________________________________________________________
___________________________________________________________
___________________________________________________________
6. Provide the names of the companies that verify the unloading of barges
into terminal(s)?
___________________________________________________________
___________________________________________________________
___________________________________________________________
7. List the names and 637 Numbers of all position holders in the terminal(s).
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
8. Provide the name and addresses of any unregistered position holders that
have held inventory in any of your terminals in the last two years.
___________________________________________________________
___________________________________________________________
___________________________________________________________
9. What does the terminal do with transmix?
___________________________________________________________
___________________________________________________________
10. Does the company allow incoming trucks to off load product? If so,
indicate the type and average volume of product received.
___________________________________________________________
___________________________________________________________
___________________________________________________________

12. Describe the facilities used to remove fuel from your terminals. Include
whether they use a card lock, key lock or another system?
______________________________________________________________
______________________________________________________________
______________________________________________________________

TIN -

DATE -

13. Describe how the company accounts for overages and shortages of inventory
at their terminals.
______________________________________________________________
______________________________________________________________
______________________________________________________________
14. Does the company take a position in overage of inventory?
______________________________________________________________
______________________________________________________________
15. As a terminal operator, are you required to file Form 720-TO, Terminal
Operator Report? If not, please explain.
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________

17. Provide a schematic of each terminal that the company operates.

TIN -

DATE -

Industrial User
1. List the fuel products being purchased.
______________________________________________________________
______________________________________________________________
2. How will the taxable fuel products be received?
______________________________________________________________
______________________________________________________________
3. For what purpose are the taxable fuel products being used?
______________________________________________________________
______________________________________________________________
4. Have the taxable fuel products been resold, or plan to be resold? If so, to
whom?
______________________________________________________________
______________________________________________________________

TIN -

DATE -

Throughputter/Position Holder
1. Indicate where the company will own product in the bulk transfer system.
______________________________________________________________
______________________________________________________________
______________________________________________________________
2. List the name, address and Form 637 Registration Number of any other party
who will pull product from the position holder's position. CEP or large oil
companies may be exempted from this question.
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
3. List your annual or projected sales of product.
a. Regular Unleaded Gasoline _____________________________________
b. Mid-grade Unleaded Gasoline ___________________________________
c. Premium Unleaded Gasoline Oxygenated Gasoline___________________
d. Gasohol ____________________________________________________
e. Diesel Fuel - High Sulfur _______________________________________
f. Diesel Fuel - Low Sulfur - Dyed __________________________________
g. Diesel Fuel - Low Sulfur - Clear __________________________________
h. Aviation Gasoline _____________________________________________
i. Jet Fuel _____________________________________________________
j. Kerosene - Clear _____________________________________________
k. Kerosene - Dyed______________________________________________
l. Blend Stocks ________________________________________________
m. Additives ____________________________________________________
4. Has the company made any in-tank transfers or sales to any entity that is not
registered with a 637 "S" registration number? If so, indicate the name and
address of the customer, volume, product and date of each sale or transfer.
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
5. Describe the records used to determine the removals of taxable fuels from the
terminal(s).
______________________________________________________________
______________________________________________________________

TIN -

DATE -

Exporter
1. List the type of taxable fuel product being exported.
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
____________________________
2. List the name and address of customer and list the final destination of the
exported product.
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
____________________________
3. List the type of export documents that are being secured.
______________________________________________________________
______________________________________________________________
______________________________________________________________
_____________________
4. How are the exported products being transported?
______________________________________________________________
______________________________________________________________
______________________________________________________________
_____________________
5. Is Federal Excise Tax being charged on the product being pulled from the rack
for export? If so, how is the refund/credit being claimed?
______________________________________________________________
______________________________________________________________
______________________________________________________________
_____________________

TIN -

DATE -

Name:
Address:
City, State, Zip

EIN:
Registration No:

"UA" QUESTIONNAIRE

(Revision 02-01-2006)

Ultimate vendor that sells kerosene for use in avaition.
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. Does the company sell or plan to sell any kerosene 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 name and address of all the company's suppliers of kerosene.

_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

TIN -

DATE -

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

_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
7. List all locations and storage facilities where kerosene is stored. List the expected
volume (in gallons) of kerosene sold. Attach additional sheets if needed. (CEP and
major oil companies may be exempted from this question.)
Name of Facility

Address of Facility

Capacity of
Kerosene Fuel
Tank(s)

Expected
Annual Volume

Indicate with an (*) any facility where dyed kerosene fuel is sold.
8. Are all pumps dispensing dyed diesel fuel or kerosene labeled with a legible and
conspicuous notice stating "DYED DIESEL FUEL, NONTAXABLE USE ONLY,
PENALTY FOR TAXABLE USE “ or DYED KEROSENE, NONTAXABLE USE ONLY,
PENALTY FOR TAXABLE USE “?

____________________________________________________________________
9. Are you or your customers reimbursed for the federal excise tax on kerosene for any
credit card sales? If so, explain.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
10. What are your procedures for securing exemption certificates / letters of registration
from customers who purchase without the federal excise tax?

TIN -

DATE -

11. Furnish the following information for each aircraft: Attach additional sheets if
necessary.(if required)
Make &
Type

Tail
Number

Takeoff
Weight

Own/
Operate

Avg Hrs
Per Month

Commercial Aviation
Avg Hrs/Month

12. If you do not own the aircraft or provide the pilot for any flight(s) of the above aircraft,
explain the operating arrangements.
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
13. Does the company provide air transportation of persons, property, or both?
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
14. Does the company provide international air transportation of persons, property, or
both?
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
15. Describe any fueling agreements with other carriers.
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
16. Does the company claim credits or refunds for aviation fuel? Explain
___________________________________________________________________
___________________________________________________________________

17.Please list all noncommercial airlines with taxpayer identification numbers that you
provide kerosene to. ___________________________________________________

_____________________________________________________________________
_____________________________________________________________________

TIN -

DATE -

TIN -

DATE -

Name
Address
City, State, Zip

EIN:
Registration No

"UB" QUESTIONNAIRE

(Revision 02-01-2006)

Ultimate vendor that sells undyed diesel fuel or undyed kerosene for certain
intercity and local buses. Definitions—(1) Intercity bus transportation—(i) In
general. An automobile bus is engaged in intercity bus transportation if it is
engaged in the furnishing (for compensation) of passenger land transportation
available to the general public and the bus is engaged in- (A) Scheduled
transportation along regular routes; or (B) Nonscheduled transportation if the
seating capacity of the bus is at least 20 adults (not including the driver).
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. Does the company sell or plan to sell any diesel fuel or kerosene 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. Does your company provide an exclusive contract for the sell of undyed diesel fuel or
undyed kerosene for certain intercity and local buses?

_____________________________________________________________________
_____________________________________________________________________

TIN -

DATE -

6. Are you registered or required to be registered by state or local authorities for the
petroleum business? If so, list the licensing agencies and numbers and dates
granted.
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
7. List all locations and storage facilities where diesel fuel is stored. List the expected
volume (in gallons) of diesel fuel used at each facility. If facility does not have bulk
storage, and all diesel fuel is delivered directly into the fuel supply of buses, notate
Bus in the column "Capacity of Diesel Fuel Tanks". Attach additional sheets if
needed. (CEP and major oil companies may be exempted from this question.)
Name of Facility

Address of Facility

Capacity of
Diesel Fuel Tank(s)

Expected
Annual Volume

Indicate with an (*) any tank that contains dyed diesel or dyed kerosene
8. Furnish the following information for all vehicles used by your company: Attach
additional sheet if necessary. Indicate in the column "Type of Fuel Used":
Dyed = Dyed Diesel Fuel; Undyed = Undyed Diesel Fuel; or Dyed kerosene or
Undyed Kerosene or Gasoline.
Model

Year

License Plate
#

Seating
Capacity

Type Fuel
Used

9. Are claims or credits being filed for undyed diesel fuel or undyed kerosene used in
intercity or local buses? If yes, what form is the company using to file the claim?
_________________________________________________________________
_________________________________________________________________
____________
TIN DATE -

10. Does the company provide diesel fuel or kerosene or public or private school buses?
If yes, provide the name and address of the bus company or schools district.
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_____________
11. Does the company that you sell diesel fuel or kerosene to have a regular scheduled
intercity or local bus transportation? If yes, provide the route schedules.
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
__________
12. Does the company store any diesel fuel or kerosene to which it does not hold title? If
so, where is this inventory stored? For whom is it stored? Are separate inventory
records maintained?

_____________________________________________________________________
_____________________________________________________________________
13. List all locations and storage facilities where diesel fuel or kerosene is stored that will
sell undyed diesel fuel or kerosene to intercity and local buses. List the expected
volume (in gallons) of undyed diesel fuel or kerosene sold to these entities. Attach
additional sheets if needed. (CEP and major oil companies may be exempted from
this question.)

Name of Facility

Address of Facility

Capacity of
Fuel Tank(s)

Expected
Annual Volume

Indicate with an (*) any facility where dyed diesel fuel is sold.
14. Are all pumps dispensing dyed diesel fuel or kerosene labeled with a legible and
conspicuous notice stating "DYED DIESEL FUEL, NONTAXABLE USE ONLY,
PENALTY FOR TAXABLE USE “ or DYED KEROSENE, NONTAXABLE USE ONLY,
PENALTY FOR TAXABLE USE “?
___________________________________________________________________

TIN -

DATE -

15. Are you or your customers reimbursed for the federal excise tax on diesel fuel or
kerosene for any credit card sales? If so, explain.
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
16. What are your procedures for securing exemption certificates from customers who
purchase without the federal excise tax?
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
17. List the names and addresses of all customers that you have sold or plan to sell
undyed diesel fuel and/or kerosene without the federal excise tax? Indicate with an *
any customer who purchases in bulk quantities.
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
18. Do you sell biodiesel?
__________________________________________________________________
19. 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 and
farmers for farming purposes?
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
20. 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 and
farmers for farming purposes?
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
21. Have any of your drivers inadvertently mixed undyed diesel fuel with dyed diesel fuel
(or visa versa) or kerosene? If so, what was done with the fuel and was a claim
filed?
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

TIN -

DATE -

TIN -

DATE -

Name:
Address:
City, State, Zip

EIN:
Registration No:

"UP" QUESTIONNAIRE

(Revision 02-01-2006)

Ultimate vendor that sells kerosene from a blocked pump.
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. Does the company sell or plan to sell any kerosene 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 name and addresses of all suppliers of kerosene.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

TIN -

DATE -

6. Does the company store any kerosene to which it does not hold title? If so, where is
this inventory stored? For whom is it stored? Are separate inventory records
maintained?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
7. List all locations and storage facilities where kerosene is stored. Attach additional
sheets if needed. (CEP and major oil companies may be exempted from this
question.)
Name of Facility

Address of Facility

Capacity of
K-1 Tank(s)

Expected
Annual Sales

Indicate with an (*) any facility where the kerosene pump is not physically blocked.
8. If applicable, what procedures are in place for your employees when selling kerosene
from a pump that is not physically blocked?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
9. Are all kerosene pumps dispensing undyed kerosene on which credit is being claimed
labeled with a legible and conspicuous notice stating “UNDYED UNTAXED
KEROSENE, NONTAXABLE USE ONLY”?
_____________________________________________________________________
10. How often is inventory of kerosene taken? Who checks inventory and how? What
records are maintained?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

TIN -

DATE -

11. What records are used to prepare claims for undyed kerosene sold without the federal
excise tax?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

TIN -

DATE -

Name:
Address:
City, State, Zip

EIN:
Registration No:

"UV" QUESTIONNAIRE

(Revision 02-06-2006)

Ultimate vendor that sells (a) undyed diesel fuel or undyed kerosene to a state or
local government for its exclusive use or (b) gasoline (including aviation gasoline
to a state or local government for its exclusive use or to a nonprofit educational
for 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. Does the company sell or plan to sell any diesel fuel, kerosene, or gasoline 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?

_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

TIN -

DATE -

5. List the name and address of all the company's suppliers of gasoline, diesel fuel, or
kerosene.

_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

6. Does the company store any gasoline, kerosene, 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?

_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
7. List all locations and storage facilities where gasoline, kerosene, and diesel fuel is
stored that will sell undyed diesel fuel or gasoline to state/local governments or nonprofit educational organization. List the expected volume (in gallons) of undyed
gasoline /diesel/kereosene fuel sold to these entities. Attach additional sheets if
needed. (CEP and major oil companies may be exempted from this question.)

Name of Facility

Address of Facility

Capacity of
Tank(s)

Expected
Annual Volume

Indicate with an (*) any facility where dyed diesel fuel is sold.
8. Are all pumps dispensing dyed diesel fuel or kerosene labeled with a legible and
conspicuous notice stating "DYED DIESEL FUEL, NONTAXABLE USE ONLY,
PENALTY FOR TAXABLE USE “ or DYED KEROSENE, NONTAXABLE USE ONLY,
PENALTY FOR TAXABLE USE “?

____________________________________________________________________
___________________________________________________________________

TIN -

DATE -

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

_____________________________________________________________________
____________________________________________________________________
11. List the names and addresses of all customers that you have sold or plan to sell
undyed diesel fuel and/or kerosene without the federal excise tax? Indicate with an *
any customer who purchases in bulk quantities.

_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
12. Do you sell biodiesel?

_____________________________________________________________________
13. 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 governments and/or
nonprofit educational organizations?

_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
15. Have any of your drivers inadvertently mixed undyed diesel fuel with dyed diesel fuel
(or visa versa) or kerosene? If so, what was done with the fuel and was a claim
filed?
___________________________________________________________________
___________________________________________________________________

TIN -

DATE -

Name:
Address:
City, State, Zip

EIN:
Registration No:

“V” QUESTIONNAIRE

(Revision 02-01-2006)

Manufacturer, importer, or buyer of ozone-depleting chemicals (ODC’s) 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 ozone-depleting chemicals 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 ozone-depleting chemicals you import or manufacture for export.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

TIN -

DATE -

6. List the name and address of companies from which you buy ozone-depleting
chemicals.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
7. List the products you manufacture, import, or buy for export.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
8. List the number of pounds for each ozone-depleting chemical exported in this
calendar year and an estimate for the next calendar year.
_____________________________________________________________________
_____________________________________________________________________
9. List your export locations.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
10. List your production allowance, export allowance, and export percentage as set by the
Environmental Protection Agency.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
11. How do you calculate the amount of credit or refund related to an exported article that
contains ozone-depleting chemicals?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
12. Please describe the proof of export the company plans to obtain to verify the articles
were actually exported.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

TIN -

DATE -

13. Provide the name and address of any brokers used to export ozone-depleting
chemicals.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

TIN -

DATE -

Name:
Address:
City, State, Zip

EIN:
Registration No:

“X” QUESTIONNAIRE

(Revision 02-01-2006)

Pipeline operator or vessel operator (including certain deep-draft vessels) within
the bulk transfer/terminal system..

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. Does the company, related company, or any of its owners incur any liability for
excise tax? If so, name the type of tax.
_____________________________________________________________________
_____________________________________________________________________
2. Does the company sell or plan to sell any taxable fuel? If so, describe the
arrangements.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
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?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
4. Does the company store or ship any fuel to which it holds title? If so, where is this
inventory stored? For who is it stored? Are separate inventory records maintained?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
5. Are you registered or required to be registered by state or local authorities? If so, list
the licensing agencies and numbers and dates granted.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

TIN -

DATE –

6. Provide the estimated annual volume of gasoline, undyed and dyed diesel fuel, and
kerosene that will be shipped or imported from another country.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
7. List all liquid products that are received from or delivered to a fuel terminal.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
8. Provide a map of each pipeline that you operate with the name and address of each
refinery, terminal, and transfer station served by each pipeline.
_____________________________________________________________________
9. Provide a map of each route in which the vessel operates and the name and address
of each refinery and terminal served by the vessel.
_____________________________________________________________________
10. List the identifying number of all vessels you operate that transport taxable fuel
(gasoline, diesel fuel and/or kerosene), and state their capacity. Attach extra sheets
if necessary. Exclude deep draft ocean-going vessels.
Vessel or Barge Number

TIN -

Home Port

Capacity

DATE –

11. As a bulk transport carrier (barge, vessels, and pipelines), are you required to file
Form 720-CS, Carrier Summary Report? If not, please explain _________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

TIN -

DATE –

Name:
Address:
City, State, Zip

EIN:
Registration No:

“Y” QUESTIONNAIRE

(Revision 02-01-2006)

Buyer of kerosene for its use in commerical aviation (other than foreign trade).

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, 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. Does the company sell or plan to sell any aviation fuel 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 name and address of all the company's suppliers of aviation fuel.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

TIN -

DATE -

6. Does the company resell aviation fuel? If so, to whom?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
7. Does the company store any aviation fuel to which it does not hold title? If so, where
is this inventory stored? For who is it stored? Are separate inventory records
maintained?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
8. List all locations and storage facilities where aviation fuel is stored. List the expected
annual volume (in gallons) of aviation fuel used at these facilities. Attach additional
sheets if needed. (CEP and major oil companies may be exempted from this
question.)
Name of Facility

Address of Facility

Capacity of
Aviation Fuel Tank(s)

Expected
Annual Volume

Indicate with an (*) any facility where aviation fuel purchased at reduced rate is resold.
9. Are you registered or required to be registered by state or local authorities for the
petroleum business? If so, list the licensing agencies and numbers and dates granted.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
10. Is the company involved in any commercial aviation in which federal excise tax on
air transportation is not charged? If so, explain.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

TIN -

DATE -

11. Furnish the following information for each aircraft: Attach additional sheets if
necessary.
Make &
Type

Tail
Number

Takeoff
Weight

Own/
Operate

Avg Hrs
Per Month

Commercial Aviation
Avg Hrs/Month

12. If you do not own the aircraft or provide the pilot for any flight(s) of the above
aircraft, explain the operating arrangements.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
13. Does the company provide air transportation of persons, property, or both?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
14. Does the company provide international air transportation of persons, property, or
both?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
15. Describe any fueling agreements with other carriers.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
16. Does the company claim credits or refunds for aviation fuel? Explain
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

TIN -

DATE -

TIN -

DATE -

Applicant/Registrant Name:
Agent Name:

EIN:
Badge Number:

Period(s)
Date:

Form 637 Activity Letter “S” Questionnaire

Activity Letter S: Enterer, position holder, refiner, terminal operator, or throughputter of gasoline, diesel
fuel (including a diesel-water fuel emulsion), or kerosene, or industrial user of gasoline.

REGISTRATION TESTS – ACTIVITY “S”

1) The Activity Test under §48.4101-1(f)(2).
2) The Acceptable Risk test under §48.4101-1(f)(3).
3) The Adequate Security Test under §48.4101-1(f)(4).
ACTIVITY TEST

1. Check the box(es) representing the activity(ies) and the type of taxable fuel in which the entity
is engaged in or likely to become engaged in within a reasonable time.
Activity(ies)
Refiner
Importer/Enterer
Terminal Operator
Throughputter
Industrial User
Position holder
Exporter

Gasoline

Diesel Fuel

Kerosene

Other

2. Check the box(es) representing all means by which the entity receives or disposes of
taxable fuel.

Mode of Transporation
Barge
Pipeline
Rail
Truck
Ocean Going Vessel
In-Tank Transfers

Receipts

Disposals

Exchange Agreements

REFINERS
1. List the name and address of the pipeline operators, barge companies, and/or ocean-going
vessel operators that supplies crude oil and identify the mode of transportation.
Form 637 Activity Letter “S” Questionnaire
Workpaper # -1.1
Rev. 3/2008

Applicant/Registrant Name:
Agent Name:

EIN:
Badge Number:

Period(s)
Date:

Form 637 Activity Letter “S” Questionnaire

Name and Address of Operator(s) Pipeline Barge Vessel

2. List the types of taxable fuel the refinery produces (e.g. 87 octane, #3 diesel fuel, types of
gasoline blendstocks, etc) and the production capacity per day per product.
Types of Taxable Fuel Produced Production Capacity Per Day

3. What does the entity do with transmix? Indicate how the transmix is received. Provide the name and
address of the carrier(s) if not listed above (see question 1).

Form 637 Activity Letter “S” Questionnaire
Workpaper # -1.2
Rev. 3/2008

Applicant/Registrant Name:
Agent Name:

EIN:
Badge Number:

Period(s)
Date:

Form 637 Activity Letter “S” Questionnaire

Name and Address of Carrier(s) Mode of Transportation

4. Provide a schematic of each refinery the entity operates.

Form 637 Activity Letter “S” Questionnaire
Workpaper # -1.3
Rev. 3/2008

Applicant/Registrant Name:
Agent Name:

EIN:
Badge Number:

Period(s)
Date:

Form 637 Activity Letter “S” Questionnaire

IMPORTER/ENTERER
1. Identify the name and address of suppliers of taxable fuel, type of taxable fuel imported, quantity
imported, and the origin of the imported taxable fuel.
Supplier’s Name and Address

Taxable Fuel Imported

Quantity

Origin of Imported Taxable Fuel

2. Identify the ports of entry and location of the imported taxable fuel.

Ports of Entry

Location of Port

3. Identify the carrier(s) used to import taxable fuel and the taxable fuel imported.

Name of Carrier(s) and Address

Taxable Fuel Imported

Form 637 Activity Letter “S” Questionnaire
Workpaper # -1.4
Rev. 3/2008

Applicant/Registrant Name:
Agent Name:

EIN:
Badge Number:

Period(s)
Date:

Form 637 Activity Letter “S” Questionnaire
TERMINAL OPERATOR

1. Provide the name, telephone number, and address of all terminal managers.
Name of Terminal Manager Telephone Number Address of Terminal

2. Is the entity a for hire terminal?
3. Does the entity dye diesel fuel at the terminal? If so, describe the
dye injection system used.

4. Does the entity own any of the products in the terminal(s)? If so,
specify the products owned?

5. Provide a schematic of each terminal the entity owns and/or
operates.
6. Provide the names of the companies that verify the unloading of barges into terminal(s)?

Form 637 Activity Letter “S” Questionnaire
Workpaper # -1.5
Rev. 3/2008

Applicant/Registrant Name:
Agent Name:

EIN:
Badge Number:

Period(s)
Date:

Form 637 Activity Letter “S” Questionnaire
7. List the names and 637 Numbers of all Position Holders in the terminal(s), and identify the
taxable fuel stored.
Position Holder’s Name 637 Registration Number Taxable Fuel Stored

8. What does the entity do with transmix? Indicate how the transmix is received. Provide the name and
address of the carrier(s) if not previously listed.

Name and Address of Carrier(s) Mode of Transportation

Form 637 Activity Letter “S” Questionnaire
Workpaper # -1.6
Rev. 3/2008

Applicant/Registrant Name:
Agent Name:

EIN:
Badge Number:

Period(s)
Date:

Form 637 Activity Letter “S” Questionnaire

INDUSTRIAL USER
1. List the gasoline blendstock(s) the entity purchases or intend to purchase.

2. How will the gasoline blendstock(s) be received by the entity?

3. For what purpose will the entity be using the gasoline blendstock(s)?

4. Have any gasoline blendstock(s) been resold, or plan to be resold? If so to whom?

Form 637 Activity Letter “S” Questionnaire
Workpaper # -1.7
Rev. 3/2008

Applicant/Registrant Name:
Agent Name:

EIN:
Badge Number:

Period(s)
Date:

Form 637 Activity Letter “S” Questionnaire

THROUGHPUTTER/POSITION HOLDER
1. Indicate where the entity owns or will own taxable fuel in the bulk transfer/terminal system.
Bulk Transfer/Terminal System
Refinery
Pipeline
Vessel
Terminal

YES

2. List the name, address and Form 637 Registration Number of any other party who will pull

taxable fuel from the entity’s position at the terminal(s). CEP or large oil companies may be
exempted from this question.
Name and Address of Other Party 637 Registration Number

3. Describe the records used to determine the receipt and/or removal of taxable fuel from the

terminal(s) in which taxable fuel is being stored.
Acceptable Risk Test
1. Has the entity or a related person been penalized for a
wrongful act? If yes, explain. (For initial registrations, review
the applicant’s responses to the questions listed in Part III,
Section C, Page 2 of Form 637.)
Explanation:

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

Form 637 Activity Letter “S” Questionnaire
Workpaper # -1.8
Rev. 3/2008

Applicant/Registrant Name:
Agent Name:

EIN:
Badge Number:

Period(s)
Date:

Form 637 Activity Letter “A” Questionnaire

Activity Letter “A” - Manufacturer of gas guzzler automobiles, sport fishing equipment (including
fishing rods and fishing poles), fishing tackle boxes, bows, quivers, broadheads, points, arrow
shafts, taxable tires, or vaccines.
REGISTRATION TESTS – ACTIVITY “A”

1) The applicant must meet the activity test under §48.4101-1(f)(2).
2) The applicant must have a satisfactory filing, deposit, payment, reporting, and claim history for
all federal taxes of the applicant and any related person (as defined in §48.4101-1(b)(5)).
ACTIVITY TEST
1. List all articles manufactured and explain the company’s manufacturing process. Attach advertising
brochures if available.

2. List the name and address of organizations or businesses to which the entity sells or will sell articles to
tax-free

3. List the monthly volume of tax-free articles the entity sell or intend to sell.

4. List the monthly volume of taxed articles the entity sell or intend to sell.

5. Does the entity export, or sell to a subsequent buyer for export?

6. What records are maintained by the entity to verify that the products are exported or subsequently
exported?

7. Has the entity imported any taxable articles? Is so, specify the taxable articles imported.

Satisfactory Tax History
1. Have all filings, deposits, and payments for all taxes of the entity and all related persons been made
timely? If no, explain.

Form 637 Activity Letter “A” Questionnaire
Workpaper # -1.1
Rev. 3/2008

Applicant/Registrant Name:
Agent Name:

EIN:
Badge Number:

Period(s)
Date:

Form 637 Activity Letter “AB” Questionnaire

Activity Letter “AB” – Producers and importers of agri-biodiesel.

REGISTRATION TESTS – ACTIVITY “AB”

1) The applicant must meet the activity test under §48.4101-1(f)(2).
2) The applicant must have a satisfactory filing, deposit, payment, reporting, and claim history for
all federal taxes of the applicant and any related person (as defined in §48.4101-1(b)(5)).
ACTIVITY TEST
1. List the name and address of all the entity’s supplier(s) of agri-biodiesel and the gallons purchased
annually from each.

Supplier(s) of Agri-biodiesel

Supplier’s Address

Gallons Purchased

2. Is the agri-biodiesel produced or imported by the applicant a pure fuel or is it blended with petroleum
diesel? If blended, list the percentage of blend.

3. List all production agreements with agri-biodiesel marketing firms that the entity plans on implementing
within the year.

4. Will the entity be selling agri-biodiesel as a distributor?
5. What are the entity’s procedures for securing exemption certificates from customers who purchase
without the federal excise tax?

6. Is the entity or the entity’s customers reimbursed for the federal excise tax on agri-biodiesel fuel for any
credit card sales? If so, explain.

Satisfactory Tax History
1. Have all filings, deposits, and payments for all taxes of the entity and all related persons been made
timely? If no, explain.
Form 637 Activity Letter “AB” Questionnaire
Workpaper # -1.1
Rev. 3/2008

Applicant/Registrant Name:
Agent Name:

EIN:
Badge Number:

Period(s)
Date:

Form 637 Activity Letter “AF” Questionnaire

Activity Letter “AF” - Producers and importers of alcohol.
REGISTRATION TESTS – ACTIVITY “AF”

1) The applicant must meet the activity test under §48.4101-1(f)(2).
2) The applicant must have a satisfactory filing, deposit, payment, reporting, and claim history for
all federal taxes of the applicant and any related person (as defined in §48.4101-1(b)(5)).
ACTIVITY TEST
1. List the name and address of all suppliers of alcohol and the annual amount purchased.

Name and Address of Supplier(s) of Alcohol

Gallons Purchased

2. List the type & proof, monthly gallons, and percentage of alcohol purchased used in the production of
gasohol.
Type & Proof of Alcohol

Monthly Gallons
Purchased

Percentage used in the
Production of Gasohol

3. List the approximate number of gallons produced for each type of gasohol annually.
Type of Gasohol Annual Gallons Produced
10% Gasohol
7.7% Gasohol
5.7% Gasohol
Form 637 Activity Letter “AF” QUestionnaire
Workpaper # -1.1
Rev. 3/2008

Applicant/Registrant Name:
Agent Name:

EIN:
Badge Number:

Period(s)
Date:

Form 637 Activity Letter “AF” Questionnaire

4. Describe the process used to produce alcohol.

Satisfactory Tax History
1. Have all filings, deposits, and payments for all taxes of the entity and all related persons been made
timely? If no, explain.

Form 637 Activity Letter “AF” QUestionnaire
Workpaper # -1.2
Rev. 3/2008

Applicant/Registrant Name:
Agent Name:

EIN:
Badge Number:

Period(s)
Date:

Form 637 Activity Letter “AM” Questionnaire

Activity Letter “AM” - Alternative fueler that produces an alternative fuel mixture that is sold for use
or used in the alternative fueler’s trade or business.
REGISTRATION TESTS – ACTIVITY “AM”

1) The applicant must meet the activity test under §48.4101-1(f)(2).
2) The applicant must have a satisfactory filing, deposit, payment, reporting, and claim history for
all federal taxes of the applicant and any related person (as defined in §48.4101-1(b)(5)).
ACTIVITY TEST
1. Describe the type of alternative fuel mixture that the entity will produce for sale or for use in their trade of
business.

2. List the type of taxable fuel and the monthly volume of taxable fuel bought for producing an alternative fuel
mixture.

Type of Taxable Fuel Monthly Volume

3. List the monthly volume and type(s) of alternative fuel bought or produced for blending with gasoline, diesel
fuel, or kerosene.

Type of Alternative Fuel Monthly Volume Produced

4. List all locations and storage facilities where alternative fuel mixture is stored, and the storage capacity.
Form 637 Activity Letter “AM” Questionnaire
Workpaper # -1.1
Rev. 3/2008

Applicant/Registrant Name:
Agent Name:

EIN:
Badge Number:

Period(s)
Date:

Form 637 Activity Letter “AM” Questionnaire

Attach additional sheets if needed. (CEP and major oil companies may be exempted from this question.).
Name and Address of Facility(ies)

Number of Storage
Tanks

Capacity of
Fuel Tank(s)

5. List the names and addresses of all customers that the entity has sold or plan to sell alternative fuel
mixtures without the federal excise tax.
Customer’s Name

Customer’s Address

Satisfactory Tax History
1. Have all filings, deposits, and payments for all taxes of the entity and all related persons been made timely?
If no, explain.

Form 637 Activity Letter “AM” Questionnaire
Workpaper # -1.2
Rev. 3/2008

Public Laws (P.L)
Regulations are developed (proposed, temp, final)
Notices, pr

Applicant/Registrant Name:
Agent Name:

EIN:
Badge Number:

Period(s)
Date:

Form 637 Activity Letter “D” Questionnaire

Activity Letter “D” - Buyer of sport fishing equipment (including fishing rods and fishing poles),
fishing tackle boxes, gas guzzler automobiles, bows, quivers, broadheads, points, or vaccines for
export or for resale to a second purchaser for export.
REGISTRATION TESTS – ACTIVITY “B”

1) The applicant must meet the activity test under §48.4101-1(f)(2).
2) The applicant must have a satisfactory filing, deposit, payment, reporting, and claim history for
all federal taxes of the applicant and any related person (as defined in §48.4101-1(b)(5)).
ACTIVITY TEST
1. Does the applicant/registrant export any articles? If so, specify the articles exported.

2. Is the applicant/registrant the exporter, or does the applicant/registrant sell to a subsequent buyer for
export?

3. What records are maintained by the applicant to verify that the products were exported or subsequently
exported?

4. Has the applicant /registrant imported any taxable articles? Is so, specify the taxable articles imported.

Satisfactory Tax History
1. Have all filings, deposits, and payments for all taxes of the entity and all related persons been made
timely? If no, explain.

Form 637 Activity Letter “B” Questionnaire
Workpaper # -1.1
Rev. 3/2008

Public Laws (P.L)
Regulations are developed (proposed, temp, final)
Notices, procedures, guidelines are developed (Notices, R.P.)
Forms are develope

Applicant/Registrant Name:
Agent Name:

EIN:
Badge Number:

Period(s)
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

Form 637 Activity Letter “M” Questionnaire
Workpaper # -1.1
Rev. 3/2008

Applicant/Registrant Name:
Agent Name:

EIN:
Badge Number:

Period(s)
Date:

Form 637 Activity Letter “M” Questionnaire

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 agriForm 637 Activity Letter “M” Questionnaire
Workpaper # -1.2
Rev. 3/2008

Applicant/Registrant Name:
Agent Name:

EIN:
Badge Number:

Period(s)
Date:

Form 637 Activity Letter “M” Questionnaire

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?
2. Does the entity meet the adequate security test?

A620,B700, &
B705
A620,B700, &
B705

Form 637 Activity Letter “M” Questionnaire
Workpaper # -1.3
Rev. 3/2008

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File Modified	2014-05-09
File Created	2014-05-09