Form 637 Form 637 Questionnaires

Form 637 Questionnaires

Questionnaires_Form 637

Form 637 Questionnaires

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⚠️ Notice: This form may be outdated.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:
OMB No. 1545-0014

"A" QUESTIONNAIRE

(Revision 01-21-2015)

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.
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.

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

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.

________________________________________________________________________________________
Privacy Act and Paperwork Reduction Act Notice. We ask for the information on Form 637 “A”
Questionnaire to carry out the Internal Revenue laws of the United States. We need it to figure and collect the
right amount of tax. Subtitle D of the Internal Revenue Code, Miscellaneous Excise Taxes, imposes certain
excise taxes. Section 4101 requires certain persons to register for excise taxes on fuel, as imposed by
sections 4041 and 4081. Sections 4101, 4222, and 4682 allow certain other manufacturers, sellers, or
purchasers to register to be eligible for credits or to be exempt from the excise tax on taxable articles. If you
are required to register under section 4101 or if you elect to register for credits and/or exemption, you are
required to provide the information requested on this form. Failure to provide this information may subject
persons required to register to penalties, and may delay or prevent the processing of a voluntary registration
for credits or exemption; providing false information may subject you to penalties. Section 6109 requires you
to provide the requested identification numbers.
You are not required to provide the information requested on a form that is subject to the Paperwork
Reduction Act unless the form displays a valid OMB control number. Books or records relating to a form or its
instructions must be retained as long as their contents may become material in the administration of any
Internal Revenue law.
Generally, tax returns and return information are confidential, as required by section 6103. However, section
6103 allows or requires the IRS to disclose or give such information to the Department of Justice for civil and
criminal litigation; to cities, states, the District of Columbia, and U.S. commonwealths and possessions to
administer their tax laws; and to other countries under a tax treaty. We may also disclose this information to
federal and state agencies to enforce federal nontax criminal laws, or to federal law enforcement and
intelligence agencies to combat terrorism.
The time needed to complete and file Form 637 “A” Questionnaire will vary depending on individual
circumstances. The estimated average time is 45 minutes.

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

"AB" QUESTIONNAIRE (Revision 01-21-2015)
Producers and importers of agri-biodiesel. Agri-biodiesel is the fuel made from virgin vegetable
oils and animal fats.

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

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.

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

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.

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

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?

16. Do you sell agri-biodiesel on consignment? 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?

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

________________________________________________________________________________________
Privacy Act and Paperwork Reduction Act Notice. We ask for the information on Form 637 “AB”
Questionnaire to carry out the Internal Revenue laws of the United States. We need it to figure and collect the
right amount of tax. Subtitle D of the Internal Revenue Code, Miscellaneous Excise Taxes, imposes certain
excise taxes. Section 4101 requires certain persons to register for excise taxes on fuel, as imposed by
sections 4041 and 4081. Sections 4101, 4222, and 4682 allow certain other manufacturers, sellers, or
purchasers to register to be eligible for credits or to be exempt from the excise tax on taxable articles. If you
are required to register under section 4101 or if you elect to register for credits and/or exemption, you are
required to provide the information requested on this form. Failure to provide this information may subject
persons required to register to penalties, and may delay or prevent the processing of a voluntary registration
for credits or exemption; providing false information may subject you to penalties. Section 6109 requires you
to provide the requested identification numbers. You are not required to provide the information requested on
a form that is subject to the Paperwork Reduction Act unless the form displays a valid OMB control number.
Books or records relating to a form or its instructions must be retained as long as their contents may become
material in the administration of any Internal Revenue law.
Generally, tax returns and return information are confidential, as required by section 6103. However, section
6103 allows or requires the IRS to disclose or give such information to the Department of Justice for civil and
criminal litigation; to cities, states, the District of Columbia, and U.S. commonwealths and possessions to
administer their tax laws; and to other countries under a tax treaty. We may also disclose this information to
federal and state agencies to enforce federal nontax criminal laws, or to federal law enforcement and
intelligence agencies to combat terrorism.
The time needed to complete and file Form 637 “AB” Questionnaire will vary depending on individual
circumstances.

Name:
Address:
City, State, Zip

"AF" QUESTIONNAIRE

EIN:
Registration No:
OMB No. 1545-0014
(Revision 01-21-2015)

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?

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

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

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.

Expected
Annual
Volume

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

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.

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

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.

________________________________________________________________________________________
Privacy Act and Paperwork Reduction Act Notice. We ask for the information on Form 637 Questionnaire
to carry out the Internal Revenue laws of the United States. We need it to figure and collect the right amount
of tax. Subtitle D of the Internal Revenue Code, Miscellaneous Excise Taxes, imposes certain excise taxes.
Section 4101 requires certain persons to register for excise taxes on fuel, as imposed by sections 4041 and
4081. Sections 4101, 4222, and 4682 allow certain other manufacturers, sellers, or purchasers to register to
be eligible for credits or to be exempt from the excise tax on taxable articles. If you are required to register
under section 4101 or if you elect to register for credits and/or exemption, you are required to provide the
information requested on this form. Failure to provide this information may subject persons required to
register to penalties, and may delay or prevent the processing of a voluntary registration for credits or
exemption; providing false information may subject you to penalties. Section 6109 requires you to provide the
requested identification numbers.
You are not required to provide the information requested on a form that is subject to the Paperwork
Reduction Act unless the form displays a valid OMB control number. Books or records relating to a form or its
instructions must be retained as long as their contents may become material in the administration of any
Internal Revenue law.
Generally, tax returns and return information are confidential, as required by section 6103. However, section
6103 allows or requires the IRS to disclose or give such information to the Department of Justice for civil and
criminal litigation; to cities, states, the District of Columbia, and U.S. commonwealths and possessions to
administer their tax laws; and to other countries under a tax treaty. We may also disclose this information to
federal and state agencies to enforce federal nontax criminal laws, or to federal law enforcement and
intelligence agencies to combat terrorism.

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

The time needed to complete and file Form 637 Questionnaire will vary depending on individual
circumstances.

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

"B" QUESTIONNAIRE (Revision 01-21-2015)
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.

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

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.

________________________________________________________________________________________
Privacy Act and Paperwork Reduction Act Notice. We ask for the information on Form 637 “B”
Questionnaire to carry out the Internal Revenue laws of the United States. We need it to figure and collect the
right amount of tax. Subtitle D of the Internal Revenue Code, Miscellaneous Excise Taxes, imposes certain
excise taxes. Section 4101 requires certain persons to register for excise taxes on fuel, as imposed by
sections 4041 and 4081. Sections 4101, 4222, and 4682 allow certain other manufacturers, sellers, or
purchasers to register to be eligible for credits or to be exempt from the excise tax on taxable articles. If you
are required to register under section 4101 or if you elect to register for credits and/or exemption, you are
required to provide the information requested on this form. Failure to provide this information may subject
persons required to register to penalties, and may delay or prevent the processing of a voluntary registration
for credits or exemption; providing false information may subject you to penalties. Section 6109 requires you
to provide the requested identification numbers.
You are not required to provide the information requested on a form that is subject to the Paperwork
Reduction Act unless the form displays a valid OMB control number. Books or records relating to a form or its
instructions must be retained as long as their contents may become material in the administration of any
Internal Revenue law.
Generally, tax returns and return information are confidential, as required by section 6103. However, section
6103 allows or requires the IRS to disclose or give such information to the Department of Justice for civil and
criminal litigation; to cities, states, the District of Columbia, and U.S. commonwealths and possessions to
administer their tax laws; and to other countries under a tax treaty. We may also disclose this information to
federal and state agencies to enforce federal nontax criminal laws, or to federal law enforcement and
intelligence agencies to combat terrorism.

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

The time needed to complete and file Form 637 “B” Questionnaire will vary depending on individual
circumstances. The estimated average time is 45 minutes.
.

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

"C" QUESTIONNAIRE (Revision 01-21-2015)
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.

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

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.

__________________________________________________________________________________________
Privacy Act and Paperwork Reduction Act Notice. We ask for the information on Form 637 “C” Questionnaire
to carry out the Internal Revenue laws of the United States. We need it to figure and collect the right amount of
tax. Subtitle D of the Internal Revenue Code, Miscellaneous Excise Taxes, imposes certain excise taxes. Section
4101 requires certain persons to register for excise taxes on fuel, as imposed by sections 4041 and 4081.
Sections 4101, 4222, and 4682 allow certain other manufacturers, sellers, or purchasers to register to be eligible
for credits or to be exempt from the excise tax on taxable articles. If you are required to register under section
4101 or if you elect to register for credits and/or exemption, you are required to provide the information
requested on this form. Failure to provide this information may subject persons required to register to penalties,
and may delay or prevent the processing of a voluntary registration for credits or exemption; providing false
information may subject you to penalties. Section 6109 requires you to provide the requested identification
numbers.
You are not required to provide the information requested on a form that is subject to the Paperwork Reduction
Act unless the form displays a valid OMB control number. Books or
records relating to a form or its instructions must be retained as long as their contents may become material in
the administration of any Internal Revenue law.
Generally, tax returns and return information are confidential, as required by section 6103. However, section
6103 allows or requires the IRS to disclose or give such information to the Department of Justice for civil and
criminal litigation; to cities, states, the District of Columbia, and U.S. commonwealths and possessions to
administer their tax laws; and to other countries under a tax treaty. We may also disclose this information to
federal and state agencies to enforce federal nontax criminal laws, or to federal law enforcement and
intelligence agencies to combat terrorism.
The time needed to complete and file Form 55 minutes.

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

"CC" QUESTIONNAIRE (Revision 01-21-2015)
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?

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

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.

Name of Facility

Address of Facility

Capacity of Gasoline /
Diesel Fuel Tank(s)

Expected
Annual Volume

Indicate with an (*) any facility where dyed diesel fuel is sold.
7. Are you or your customers reimbursed for the federal excise tax on diesel fuel for
any credit card sales? If so, explain.

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

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?

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

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?

________________________________________________________________________________________
Privacy Act and Paperwork Reduction Act Notice. We ask for the information on Form 637 Questionnaire
to carry out the Internal Revenue laws of the United States. We need it to figure and collect the right amount
of tax. Subtitle D of the Internal Revenue Code, Miscellaneous Excise Taxes, imposes certain excise taxes.
Section 4101 requires certain persons to register for excise taxes on fuel, as imposed by sections 4041 and
4081. Sections 4101, 4222, and 4682 allow certain other manufacturers, sellers, or purchasers to register to
be eligible for credits or to be exempt from the excise tax on taxable articles. If you are required to register
under section 4101 or if you elect to register for credits and/or exemption, you are required to provide the
information requested on this form. Failure to provide this information may subject persons required to
register to penalties, and may delay or prevent the processing of a voluntary registration for credits or
exemption; providing false information may subject you to penalties. Section 6109 requires you to provide the
requested identification numbers.
You are not required to provide the information requested on a form that is subject to the Paperwork
Reduction Act unless the form displays a valid OMB control number. Books or records relating to a form or its
instructions must be retained as long as their contents may become material in the administration of any
Internal Revenue law.
Generally, tax returns and return information are confidential, as required by section 6103. However, section
6103 allows or requires the IRS to disclose or give such information to the Department of Justice for civil and
criminal litigation; to cities, states, the District of Columbia, and U.S. commonwealths and possessions to
administer their tax laws; and to other countries under a tax treaty. We may also disclose this information to
federal and state agencies to enforce federal nontax criminal laws, or to federal law enforcement and
intelligence agencies to combat terrorism.
The time needed to complete and file Form 637 Questionnaire will vary depending on individual
circumstances.

Name:
Address:
City, State, Zip

"D" QUESTIONNAIRE

EIN:
Registration No:
OMB No. 1545-0014
(Revision 01-21-2015)

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.

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

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.

________________________________________________________________________________________
Privacy Act and Paperwork Reduction Act Notice. We ask for the information on Form 637 “D”
Questionnaire to carry out the Internal Revenue laws of the United States. We need it to figure and collect the
right amount of tax. Subtitle D of the Internal Revenue Code, Miscellaneous Excise Taxes, imposes certain
excise taxes. Section 4101 requires certain persons to register for excise taxes on fuel, as imposed by sections
4041 and 4081. Sections 4101, 4222, and 4682 allow certain other manufacturers, sellers, or purchasers to
register to be eligible for credits or to be exempt from the excise tax on taxable articles. If you are required to
register under section 4101 or if you elect to register for credits and/or exemption, you are required to provide
the information requested on this form. Failure to provide this information may subject persons required to
register to penalties, and may delay or prevent the processing of a voluntary registration for credits or
exemption; providing false information may subject you to penalties. Section 6109 requires you to provide the
requested identification numbers.
You are not required to provide the information requested on a form that is subject to the Paperwork Reduction
Act unless the form displays a valid OMB control number. Books or
records relating to a form or its instructions must be retained as long as their contents may become material in
the administration of any Internal Revenue law.
Generally, tax returns and return information are confidential, as required by section 6103. However, section
6103 allows or requires the IRS to disclose or give such information to the Department of Justice for civil and
criminal litigation; to cities, states, the District of Columbia, and U.S. commonwealths and possessions to
administer their tax laws; and to other countries under a tax treaty. We may also disclose this information to
federal and state agencies to enforce federal nontax criminal laws, or to federal law enforcement and
intelligence agencies to combat terrorism.
The time needed to complete and file Form 637 “D” Questionnaire will vary depending on individual
circumstances. The estimated average time is 40 minutes.

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

“E” QUESTIONNAIRE (Revision 01-21-2015)
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.

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

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.

________________________________________________________________________________________
Privacy Act and Paperwork Reduction Act Notice. We ask for the information on Form 637 “E”
Questionnaire to carry out the Internal Revenue laws of the United States. We need it to figure and collect the
right amount of tax. Subtitle D of the Internal Revenue Code, Miscellaneous Excise Taxes, imposes certain
excise taxes. Section 4101 requires certain persons to register for excise taxes on fuel, as imposed by
sections 4041 and 4081. Sections 4101, 4222, and 4682 allow certain other manufacturers, sellers, or
purchasers to register to be eligible for credits or to be exempt from the excise tax on taxable articles. If you
are required to register under section 4101 or if you elect to register for credits and/or exemption, you are
required to provide the information requested on this form. Failure to provide this information may subject
persons required to register to penalties, and may delay or prevent the processing of a voluntary registration
for credits or exemption; providing false information may subject you to penalties. Section 6109 requires you
to provide the requested identification numbers.
You are not required to provide the information requested on a form that is subject to the Paperwork
Reduction Act unless the form displays a valid OMB control number. Books or records relating to a form or its
instructions must be retained as long as their contents may become material in the administration of any
Internal Revenue law.
Generally, tax returns and return information are confidential, as required by section 6103. However, section
6103 allows or requires the IRS to disclose or give such information to the Department of Justice for civil and
criminal litigation; to cities, states, the District of Columbia, and U.S. commonwealths and possessions to
administer their tax laws; and to other countries under a tax treaty. We may also disclose this information to
federal and state agencies to enforce federal nontax criminal laws, or to federal law enforcement and
intelligence agencies to combat terrorism.
The time needed to complete and file Form 637 “E” Questionnaire will vary depending on individual
circumstances. The estimated average time is 30 minutes.

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

“F” QUESTIONNAIRE (Revision 01-21-2015)
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.

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

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?

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

4081. Sections 4101, 4222, and 4682 allow certain other manufacturers, sellers, or purchasers to register to
be eligible for credits or to be exempt from the excise tax on taxable articles. If you are required to register
under section 4101 or if you elect to register for credits and/or exemption, you are required to provide the
information requested on this form. Failure to provide this information may subject persons required to
register to penalties, and may delay or prevent the processing of a voluntary registration for credits or
exemption; providing false information may subject you to penalties. Section 6109 requires you to provide the
requested identification numbers.
You are not required to provide the information requested on a form that is subject to the Paperwork
Reduction Act unless the form displays a valid OMB control number. Books or records relating to a form or its
instructions must be retained as long as their contents may become material in the administration of any
Internal Revenue law.
Generally, tax returns and return information are confidential, as required by section 6103. However, section
6103 allows or requires the IRS to disclose or give such information to the Department of Justice for civil and
criminal litigation; to cities, states, the District of Columbia, and U.S. commonwealths and possessions to
administer their tax laws; and to other countries under a tax treaty. We may also disclose this information to
federal and state agencies to enforce federal nontax criminal laws, or to federal law enforcement and
intelligence agencies to combat terrorism.
The time needed to complete and file Form 637 “F” Questionnaire will vary depending on individual
circumstances. The estimated average time is 50 minutes.

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

"I" QUESTIONNAIRE (Revision 01-21-2015)
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?

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

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.

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

exemption; providing false information may subject you to penalties. Section 6109 requires you to provide the
requested identification numbers.
You are not required to provide the information requested on a form that is subject to the Paperwork
Reduction Act unless the form displays a valid OMB control number. Books or records relating to a form or its
instructions must be retained as long as their contents may become material in the administration of any
Internal Revenue law.
Generally, tax returns and return information are confidential, as required by section 6103. However, section
6103 allows or requires the IRS to disclose or give such information to the Department of Justice for civil and
criminal litigation; to cities, states, the District of Columbia, and U.S. commonwealths and possessions to
administer their tax laws; and to other countries under a tax treaty. We may also disclose this information to
federal and state agencies to enforce federal nontax criminal laws, or to federal law enforcement and
intelligence agencies to combat terrorism.
The time needed to complete and file Form 637 “I” Questionnaire will vary depending on individual
circumstances. The estimated average time is 45 minutes.

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

"K" QUESTIONNAIRE (Revision 01-21-2015)
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.

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

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.

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

requested on this form. Failure to provide this information may subject persons required to register to penalties, and
may delay or prevent the processing of a voluntary registration for credits or exemption; providing false information
may subject you to penalties. Section 6109 requires you to provide the requested identification numbers.
You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act
unless the form displays a valid OMB control number. Books or
records relating to a form or its instructions must be retained as long as their contents may become material in the
administration of any Internal Revenue law.
Generally, tax returns and return information are confidential, as required by section 6103. However, section 6103
allows or requires the IRS to disclose or give such information to the Department of Justice for civil and criminal
litigation; to cities, states, the District of Columbia, and U.S. commonwealths and possessions to administer their tax
laws; and to other countries under a tax treaty. We may also disclose this information to federal and state agencies to
enforce federal nontax criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism.
The time needed to complete and file Form 637 “K” Questionnaire will vary depending on individual circumstances.
The estimated average time is 45 minutes.

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

"M" QUESTIONNAIRE (Revision 01-21-2015)
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?

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

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

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.

Expected
Annual
Volume

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

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?

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

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?
________________________________________________________________________________________
Privacy Act and Paperwork Reduction Act Notice. We ask for the information on Form 637 “M”
Questionnaire to carry out the Internal Revenue laws of the United States. We need it to figure and collect the
right amount of tax. Subtitle D of the Internal Revenue Code, Miscellaneous Excise Taxes, imposes certain
excise taxes. Section 4101 requires certain persons to register for excise taxes on fuel, as imposed by
sections 4041 and 4081. Sections 4101, 4222, and 4682 allow certain other manufacturers, sellers, or
purchasers to register to be eligible for credits or to be exempt from the excise tax on taxable articles. If you
are required to register under section 4101 or if you elect to register for credits and/or exemption, you are
required to provide the information requested on this form. Failure to provide this information may subject
persons required to

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

register to penalties, and may delay or prevent the processing of a voluntary registration for credits or
exemption; providing false information may subject you to penalties. Section 6109 requires you to provide the
requested identification numbers.
You are not required to provide the information requested on a form that is subject to the Paperwork
Reduction Act unless the form displays a valid OMB control number. Books or records relating to a form or its
instructions must be retained as long as their contents may become material in the administration of any
Internal Revenue law.
Generally, tax returns and return information are confidential, as required by section 6103. However, section
6103 allows or requires the IRS to disclose or give such information to the Department of Justice for civil and
criminal litigation; to cities, states, the District of Columbia, and U.S. commonwealths and possessions to
administer their tax laws; and to other countries under a tax treaty. We may also disclose this information to
federal and state agencies to enforce federal nontax criminal laws, or to federal law enforcement and
intelligence agencies to combat terrorism.
The time needed to complete and file Form 637 “M” Questionnaire will vary depending on individual
circumstances. The estimated average time is 1 hour and 10 minutes.

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

"NB" QUESTIONNAIRE (Revision 01-21-2015)
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.

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

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.

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

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?

16. Do you sell biodiesel on consignment? 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?

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

__________________________________________________________________________________________
Privacy Act and Paperwork Reduction Act Notice. We ask for the information on Form 637 Questionnaire to carry
out the Internal Revenue laws of the United States. We need it to figure and collect the right amount of tax. Subtitle
D of the Internal Revenue Code, Miscellaneous Excise Taxes, imposes certain excise taxes. Section 4101 requires
certain persons to register for excise taxes on fuel, as imposed by sections 4041 and 4081. Sections 4101, 4222,
and 4682 allow certain other manufacturers, sellers, or purchasers to register to be eligible for credits or to be
exempt from the excise tax on taxable articles. If you are required to register under section 4101 or if you elect to
register for credits and/or exemption, you are required to provide the information requested on this form. Failure to
provide this information may subject persons required to register to penalties, and may delay or prevent the
processing of a voluntary registration for credits or exemption; providing false information may subject you to
penalties. Section 6109 requires you to provide the requested identification numbers.
You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act
unless the form displays a valid OMB control number. Books or records relating to a form or its instructions must be
retained as long as their contents may become material in the administration of any Internal Revenue law.
Generally, tax returns and return information are confidential, as required by section 6103. However, section 6103
allows or requires the IRS to disclose or give such information to the Department of Justice for civil and criminal
litigation; to cities, states, the District of Columbia, and U.S. commonwealths and possessions to administer their tax
laws; and to other countries under a tax treaty. We may also disclose this information to federal and state agencies
to enforce federal nontax criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism.
The time needed to complete and file Form 637 Questionnaire will vary depending on individual circumstances.

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

“Q” QUESTIONNAIRE (01-21-2015)
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)

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

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?

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

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?

________________________________________________________________________________________
Privacy Act and Paperwork Reduction Act Notice. We ask for the information on Form 637 “Q”
Questionnaire to carry out the Internal Revenue laws of the United States. We need it to figure and collect the
right amount of tax. Subtitle D of the Internal Revenue Code, Miscellaneous Excise Taxes, imposes certain
excise taxes. Section 4101 requires certain persons to register for excise taxes on fuel, as imposed by
sections 4041 and 4081. Sections 4101, 4222, and 4682 allow certain other manufacturers, sellers, or
purchasers to register to be eligible for credits or to be exempt from the excise tax on taxable articles. If you
are required to register under section 4101 or if you elect to register for credits and/or exemption, you are
required to provide the information requested on this form. Failure to provide this information may subject
persons required to register to penalties, and may delay or prevent the processing of a voluntary registration
for credits or exemption; providing false information may subject you to penalties. Section 6109 requires you
to provide the requested identification numbers.
You are not required to provide the information requested on a form that is subject to the Paperwork
Reduction Act unless the form displays a valid OMB control number. Books or records relating to a form or its
instructions must be retained as long as their contents may become material in the administration of any
Internal Revenue law.
Generally, tax returns and return information are confidential, as required by section 6103. However, section
6103 allows or requires the IRS to disclose or give such information to the Department of Justice for civil and
criminal litigation; to cities, states, the District of Columbia, and U.S. commonwealths and possessions to
administer their tax laws; and to other countries under a tax treaty. We may also disclose this information to
federal and state agencies to enforce federal nontax criminal laws, or to federal law enforcement and
intelligence agencies to combat terrorism.

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

The time needed to complete and file Form 637 “Q” Questionnaire will vary depending on individual
circumstances. The estimated average time is 1 hour and 20 minutes.

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

"S" QUESTIONNAIRE

(Revision 01-21-2015)

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.

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

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

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

8. Check the box (es) representing all means by which you receive or
dispose of fuel.
Means
Barge
Pipeline
Rail
Truck
Ocean Going Vessel

Receipts

Disposals

Other

Expected
Annual
Volume

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

In-Tank Transfers
Exchange
Agreements
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?

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

15. Does the company consign fuel? If so, list the name, address, and
relationship to those entities.

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.

________________________________________________________________________________________
Privacy Act and Paperwork Reduction Act Notice. We ask for the information on Form 637 “S”
Questionnaire to carry out the Internal Revenue laws of the United States. We need it to figure and collect the
right amount of tax. Subtitle D of the Internal Revenue Code, Miscellaneous Excise Taxes, imposes certain
excise taxes. Section 4101 requires certain persons to register for excise taxes on fuel, as imposed by sections
4041 and 4081. Sections 4101, 4222, and 4682 allow certain other manufacturers, sellers, or purchasers to
register to be eligible for credits or to be exempt from the excise tax on taxable articles. If you are required to
register under section 4101 or if you elect to register for credits and/or exemption, you are required to provide
the information requested on this form. Failure to provide this information may subject persons required to
register to penalties, and may delay or prevent the processing of a voluntary registration for credits or
exemption; providing false information may subject you to penalties. Section 6109 requires you to provide the
requested identification numbers.
You are not required to provide the information requested on a form that is subject to the Paperwork Reduction
Act unless the form displays a valid OMB control number. Books or records relating to a form or its instructions
must be retained as long as their contents may become material in the administration of any Internal Revenue
law.
Generally, tax returns and return information are confidential, as required by section 6103. However, section
6103 allows or requires the IRS to disclose or give such information to the Department of Justice for civil and
criminal litigation; to cities, states, the District of Columbia, and U.S. commonwealths and possessions to
administer their tax laws; and to other countries under a tax treaty. We may also disclose this information to
federal and state agencies to enforce federal nontax criminal laws, or to federal law enforcement and
intelligence agencies to combat terrorism.
The time needed to complete and file Form 637 “S” Questionnaire will vary depending on individual
circumstances.

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

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.
________________________________________________________________________________________
Privacy Act and Paperwork Reduction Act Notice. We ask for the information on Form 637 “For Refiners”
Questionnaire to carry out the Internal Revenue laws of the United States. We need it to figure and collect the
right amount of tax. Subtitle D of the Internal Revenue Code, Miscellaneous Excise Taxes, imposes certain
excise taxes. Section 4101 requires certain persons to register for excise taxes on fuel, as imposed by sections
4041 and 4081. Sections 4101, 4222, and 4682 allow certain other manufacturers, sellers, or purchasers to
register to be eligible for credits or to be exempt from the excise tax on taxable articles. If you are required to
register under section 4101 or if you elect to register for credits and/or exemption, you are required to provide
the information requested on this form. Failure to provide this information may subject persons required to
register to penalties, and may delay or prevent the processing of a voluntary registration for credits or
exemption; providing false information may subject you to penalties. Section 6109 requires you to provide the
requested identification numbers.

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

You are not required to provide the information requested on a form that is subject to the Paperwork Reduction
Act unless the form displays a valid OMB control number. Books or records relating to a form or its instructions
must be retained as long as their contents may become material in the administration of any Internal Revenue
law.
Generally, tax returns and return information are confidential, as required by section 6103. However, section
6103 allows or requires the IRS to disclose or give such information to the Department of Justice for civil and
criminal litigation; to cities, states, the District of Columbia, and U.S. commonwealths and possessions to
administer their tax laws; and to other countries under a tax treaty. We may also disclose this information to
federal and state agencies to enforce federal nontax criminal laws, or to federal law enforcement and
intelligence agencies to combat terrorism.
The time needed to complete and file Form 637 “For Refiners” Questionnaire will vary depending on individual
circumstances. The estimated average time is 1 hour and 55 minutes.

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

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.

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

Generally, tax returns and return information are confidential, as required by section 6103. However, section
6103 allows or requires the IRS to disclose or give such information to the Department of Justice for civil and
criminal litigation; to cities, states, the District of Columbia, and U.S. commonwealths and possessions to
administer their tax laws; and to other countries under a tax treaty. We may also disclose this information to
federal and state agencies to enforce federal nontax criminal laws, or to federal law enforcement and
intelligence agencies to combat terrorism.
The time needed to complete and file Form 637 “For Importers/Enteres” Questionnaire will vary depending on
individual circumstances. The estimated average time is 1 hour and 45 minutes.

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

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. Regular Unleaded Gasoline
b. Mid-grade Unleaded Gasoline
c. Premium Unleaded Gasoline
d. Oxygenated Gasoline
e. Gasohol
f. Racing Gasoline
g. Diesel Fuel - High Sulfur
h. Diesel Fuel - Low Sulfur - Dyed
i. Diesel Fuel - Low Sulfur - Clear
j. Aviation Gasoline
k. Jet Fuel
l. Kerosene - Clear
m. Kerosene - Dyed
n. Blend Stocks
o. 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

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

Kerosene - Clear
Kerosene - Dyed
Blend Stocks
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?

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

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.

________________________________________________________________________________________
Privacy Act and Paperwork Reduction Act Notice. We ask for the information on Form 637 “Terminal
Operators” Questionnaire to carry out the Internal Revenue laws of the United States. We need it to figure and
collect the right amount of tax. Subtitle D of the Internal Revenue Code, Miscellaneous Excise Taxes, imposes
certain excise taxes. Section 4101 requires certain persons to register for excise taxes on fuel, as imposed by
sections 4041 and 4081. Sections 4101, 4222, and 4682 allow certain other manufacturers, sellers, or
purchasers to register to be eligible for credits or to be exempt from the excise tax on taxable articles. If you
are required to register under section 4101 or if you elect to register for credits and/or exemption, you are
required to provide the information requested on this form. Failure to provide this information may subject
persons required to register to penalties, and may delay or prevent the processing of a voluntary registration
for credits or exemption; providing false information may subject you to penalties. Section 6109 requires you
to provide the requested identification numbers.
You are not required to provide the information requested on a form that is subject to the Paperwork
Reduction Act unless the form displays a valid OMB control number. Books or records relating to a form or its
instructions must be retained as long as their contents may become material in the administration of any
Internal Revenue law.
Generally, tax returns and return information are confidential, as required by section 6103. However, section
6103 allows or requires the IRS to disclose or give such information to the Department of Justice for civil and
criminal litigation; to cities, states, the District of Columbia, and U.S. commonwealths and possessions to
administer their tax laws; and to other countries under a tax treaty. We may also disclose this information to
federal and state agencies to enforce federal nontax criminal laws, or to federal law enforcement and
intelligence agencies to combat terrorism.
The time needed to complete and file Form 637 “Terminal Operators” Questionnaire will vary depending on
individual circumstances. The estimated average time is 2 hours.

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

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?

________________________________________________________________________________________
Privacy Act and Paperwork Reduction Act Notice. We ask for the information on Form 637 “Industrial
Users” Questionnaire to carry out the Internal Revenue laws of the United States. We need it to figure and
collect the right amount of tax. Subtitle D of the Internal Revenue Code, Miscellaneous Excise Taxes, imposes
certain excise taxes. Section 4101 requires certain persons to register for excise taxes on fuel, as imposed by
sections 4041 and 4081. Sections 4101, 4222, and 4682 allow certain other manufacturers, sellers, or
purchasers to register to be eligible for credits or to be exempt from the excise tax on taxable articles. If you
are required to register under section 4101 or if you elect to register for credits and/or exemption, you are
required to provide the information requested on this form. Failure to provide this information may subject
persons required to register to penalties, and may delay or prevent the processing of a voluntary registration for
credits or exemption; providing false information may subject you to penalties. Section 6109 requires you to
provide the requested identification numbers.
You are not required to provide the information requested on a form that is subject to the Paperwork Reduction
Act unless the form displays a valid OMB control number. Books or records relating to a form or its instructions
must be retained as long as their contents may become material in the administration of any Internal Revenue
law.
Generally, tax returns and return information are confidential, as required by section 6103. However, section
6103 allows or requires the IRS to disclose or give such information to the Department of Justice for civil and
criminal litigation; to cities, states, the District of Columbia, and U.S. commonwealths and possessions to
administer their tax laws; and to other countries under a tax treaty. We may also disclose this information to
federal and state agencies to enforce federal nontax criminal laws, or to federal law enforcement and
intelligence agencies to combat terrorism.
The time needed to complete and file Form 637 “Industrial Users” Questionnaire will vary depending on
individual circumstances. The estimated average time is 1 hour and 45 minutes.

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

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).

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

Section 4101 requires certain persons to register for excise taxes on fuel, as imposed by sections 4041 and
4081. Sections 4101, 4222, and 4682 allow certain other manufacturers, sellers, or purchasers to register to be
eligible for credits or to be exempt from the excise tax on taxable articles. If you are required to register under
section 4101 or if you elect to register for credits and/or exemption, you are required to provide the information
requested on this form. Failure to provide this information may subject persons required to register to penalties,
and may delay or prevent the processing of a voluntary registration for credits or exemption; providing false
information may subject you to penalties. Section 6109 requires you to provide the requested identification
numbers.
You are not required to provide the information requested on a form that is subject to the Paperwork Reduction
Act unless the form displays a valid OMB control number. Books or records relating to a form or its instructions
must be retained as long as their contents may become material in the administration of any Internal Revenue
law.
Generally, tax returns and return information are confidential, as required by section 6103. However, section
6103 allows or requires the IRS to disclose or give such information to the Department of Justice for civil and
criminal litigation; to cities, states, the District of Columbia, and U.S. commonwealths and possessions to
administer their tax laws; and to other countries under a tax treaty. We may also disclose this information to
federal and state agencies to enforce federal nontax criminal laws, or to federal law enforcement and
intelligence agencies to combat terrorism.
The time needed to complete and file Form 637 “Throughputters/Position Holders” Questionnaire will vary
depending on individual circumstances. The estimated average time is 1 hour and 50 minutes.

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

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?

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

providing false information may subject you to penalties. Section 6109 requires you to provide the requested
identification numbers.
You are not required to provide the information requested on a form that is subject to the Paperwork Reduction
Act unless the form displays a valid OMB control number. Books or records relating to a form or its instructions
must be retained as long as their contents may become material in the administration of any Internal Revenue
law.
Generally, tax returns and return information are confidential, as required by section 6103. However, section
6103 allows or requires the IRS to disclose or give such information to the Department of Justice for civil and
criminal litigation; to cities, states, the District of Columbia, and U.S. commonwealths and possessions to
administer their tax laws; and to other countries under a tax treaty. We may also disclose this information to
federal and state agencies to enforce federal nontax criminal laws, or to federal law enforcement and
intelligence agencies to combat terrorism.
The time needed to complete and file Form 637 “Exporters” Questionnaire will vary depending on individual
circumstances. The estimated average time is 1 hour and 50 minutes.

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

"UA" QUESTIONNAIRE

(Revision 01-21-2015)

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.

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

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?

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

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.

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

________________________________________________________________________________________
Privacy Act and Paperwork Reduction Act Notice. We ask for the information on Form 637 Questionnaire
to carry out the Internal Revenue laws of the United States. We need it to figure and collect the right amount
of tax. Subtitle D of the Internal Revenue Code, Miscellaneous Excise Taxes, imposes certain excise taxes.
Section 4101 requires certain persons to register for excise taxes on fuel, as imposed by sections 4041 and
4081. Sections 4101, 4222, and 4682 allow certain other manufacturers, sellers, or purchasers to register to
be eligible for credits or to be exempt from the excise tax on taxable articles. If you are required to register
under section 4101 or if you elect to register for credits and/or exemption, you are required to provide the
information requested on this form. Failure to provide this information may subject persons required to
register to penalties, and may delay or prevent the processing of a voluntary registration for credits or
exemption; providing false information may subject you to penalties. Section 6109 requires you to provide the
requested identification numbers.
You are not required to provide the information requested on a form that is subject to the Paperwork
Reduction Act unless the form displays a valid OMB control number. Books or records relating to a form or its
instructions must be retained as long as their contents may become material in the administration of any
Internal Revenue law.
Generally, tax returns and return information are confidential, as required by section 6103. However, section
6103 allows or requires the IRS to disclose or give such information to the Department of Justice for civil and
criminal litigation; to cities, states, the District of Columbia, and U.S. commonwealths and possessions to
administer their tax laws; and to other countries under a tax treaty. We may also disclose this information to
federal and state agencies to enforce federal nontax criminal laws, or to federal law enforcement and
intelligence agencies to combat terrorism.
The time needed to complete and file Form 637 Questionnaire will vary depending on individual
circumstances. The estimated average time is Recordkeeping, 7 hr., 39 min.; Learning about the law or the
form, 1 hr., 37 min.; Preparing and sending the form to the IRS, 4 hr., 13 min.
If you have comments concerning the accuracy of these time estimates or suggestions for making Form 637
simpler, we would be happy to hear from you. You can send your comments to:
Internal Revenue Service
Tax Forms and Publications Division
SE:W:CAR:MP:TFP
1111 Constitution Ave. NW, IR-6526
Washington, DC 20224
Do not send Form 637 Questionnaire to this address. Instead, see Where To Apply, earlier.

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

"UB" QUESTIONNAIRE

(Revision 01-21-2015)

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?

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

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

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

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?

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)

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

Expected
Annual Volume

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

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”
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?

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

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?

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

________________________________________________________________________________________
Privacy Act and Paperwork Reduction Act Notice. We ask for the information on Form 637 Questionnaire
to carry out the Internal Revenue laws of the United States. We need it to figure and collect the right amount
of tax. Subtitle D of the Internal Revenue Code, Miscellaneous Excise Taxes, imposes certain excise taxes.
Section 4101 requires certain persons to register for excise taxes on fuel, as imposed by sections 4041 and
4081. Sections 4101, 4222, and 4682 allow certain other manufacturers, sellers, or purchasers to register to
be eligible for credits or to be exempt from the excise tax on taxable articles. If you are required to register
under section 4101 or if you elect to register for credits and/or exemption, you are required to provide the
information requested on this form. Failure to provide this information may subject persons required to
register to penalties, and may delay or prevent the processing of a voluntary registration for credits or
exemption; providing false information may subject you to penalties. Section 6109 requires you to provide the
requested identification numbers.
You are not required to provide the information requested on a form that is subject to the Paperwork
Reduction Act unless the form displays a valid OMB control number. Books or records relating to a form or its
instructions must be retained as long as their contents may become material in the administration of any
Internal Revenue law.
Generally, tax returns and return information are confidential, as required by section 6103. However, section
6103 allows or requires the IRS to disclose or give such information to the Department of Justice for civil and
criminal litigation; to cities, states, the District of Columbia, and U.S. commonwealths and possessions to
administer their tax laws; and to other countries under a tax treaty. We may also disclose this information to
federal and state agencies to enforce federal nontax criminal laws, or to federal law enforcement and
intelligence agencies to combat terrorism.
The time needed to complete and file Form 637 Questionnaire will vary depending on individual
circumstances.

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

"UP" QUESTIONNAIRE

(Revision 01-21-2015)

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.

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

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?

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

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

________________________________________________________________________________________
Privacy Act and Paperwork Reduction Act Notice. We ask for the information on Form 637 “UP”
Questionnaire to carry out the Internal Revenue laws of the United States. We need it to figure and collect the
right amount of tax. Subtitle D of the Internal Revenue Code, Miscellaneous Excise Taxes, imposes certain
excise taxes. Section 4101 requires certain persons to register for excise taxes on fuel, as imposed by
sections 4041 and 4081. Sections 4101, 4222, and 4682 allow certain other manufacturers, sellers, or
purchasers to register to be eligible for credits or to be exempt from the excise tax on taxable articles. If you
are required to register under section 4101 or if you elect to register for credits and/or exemption, you are
required to provide the information requested on this form. Failure to provide this information may subject
persons required to register to penalties, and may delay or prevent the processing of a voluntary registration
for credits or exemption; providing false information may subject you to penalties. Section 6109 requires you
to provide the requested identification numbers.
You are not required to provide the information requested on a form that is subject to the Paperwork
Reduction Act unless the form displays a valid OMB control number. Books or records relating to a form or its
instructions must be retained as long as their contents may become material in the administration of any
Internal Revenue law.
Generally, tax returns and return information are confidential, as required by section 6103. However, section
6103 allows or requires the IRS to disclose or give such information to the Department of Justice for civil and
criminal litigation; to cities, states, the District of Columbia, and U.S. commonwealths and possessions to
administer their tax laws; and to other countries under a tax treaty. We may also disclose this information to
federal and state agencies to enforce federal nontax criminal laws, or to federal law enforcement and
intelligence agencies to combat terrorism.
The time needed to complete and file Form 637 “UP” Questionnaire will vary depending on individual
circumstances. The estimated average time is 55 minutes.

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

"UV" QUESTIONNAIRE

(Revision 01-21-2015)

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?

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

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 “?

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

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

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

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?

14. 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?

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?

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

________________________________________________________________________________________
Privacy Act and Paperwork Reduction Act Notice. We ask for the information on Form 637 “UV”
Questionnaire to carry out the Internal Revenue laws of the United States. We need it to figure and collect the
right amount of tax. Subtitle D of the Internal Revenue Code, Miscellaneous Excise Taxes, imposes certain
excise taxes. Section 4101 requires certain persons to register for excise taxes on fuel, as imposed by
sections 4041 and 4081. Sections 4101, 4222, and 4682 allow certain other manufacturers, sellers, or
purchasers to register to be eligible for credits or to be exempt from the excise tax on taxable articles. If you
are required to register under section 4101 or if you elect to register for credits and/or exemption, you are
required to provide the information requested on this form. Failure to provide this information may subject
persons required to register to penalties, and may delay or prevent the processing of a voluntary registration
for credits or exemption; providing false information may subject you to penalties. Section 6109 requires you
to provide the requested identification numbers.
You are not required to provide the information requested on a form that is subject to the Paperwork
Reduction Act unless the form displays a valid OMB control number. Books or records relating to a form or its
instructions must be retained as long as their contents may become material in the administration of any
Internal Revenue law.
Generally, tax returns and return information are confidential, as required by section 6103. However, section
6103 allows or requires the IRS to disclose or give such information to the Department of Justice for civil and
criminal litigation; to cities, states, the District of Columbia, and U.S. commonwealths and possessions to
administer their tax laws; and to other countries under a tax treaty. We may also disclose this information to
federal and state agencies to enforce federal nontax criminal laws, or to federal law enforcement and
intelligence agencies to combat terrorism.
The time needed to complete and file Form 637 “UV” Questionnaire will vary depending on individual
circumstances. The estimated average time is 1 hour and 15 minutes.

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

“V” QUESTIONNAIRE

(Revision 01-21-2015)

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.

6. List the name and address of companies from which you buy ozone-depleting
chemicals.

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

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

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

_______________________________________________________________________________________
Privacy Act and Paperwork Reduction Act Notice. We ask for the information on Form 637 “V”
Questionnaire to carry out the Internal Revenue laws of the United States. We need it to figure and collect the
right amount of tax. Subtitle D of the Internal Revenue Code, Miscellaneous Excise Taxes, imposes certain
excise taxes. Section 4101 requires certain persons to register for excise taxes on fuel, as imposed by
sections 4041 and 4081. Sections 4101, 4222, and 4682 allow certain other manufacturers, sellers, or
purchasers to register to be eligible for credits or to be exempt from the excise tax on taxable articles. If you
are required to register under section 4101 or if you elect to register for credits and/or exemption, you are
required to provide the information requested on this form. Failure to provide this information may subject
persons required to register to penalties, and may delay or prevent the processing of a voluntary registration
for credits or exemption; providing false information may subject you to penalties. Section 6109 requires you
to provide the requested identification numbers.
You are not required to provide the information requested on a form that is subject to the Paperwork
Reduction Act unless the form displays a valid OMB control number. Books or records relating to a form or its
instructions must be retained as long as their contents may become material in the administration of any
Internal Revenue law.
Generally, tax returns and return information are confidential, as required by section 6103. However, section
6103 allows or requires the IRS to disclose or give such information to the Department of Justice for civil and
criminal litigation; to cities, states, the District of Columbia, and U.S. commonwealths and possessions to
administer their tax laws; and to other countries under a tax treaty. We may also disclose this information to
federal and state agencies to enforce federal nontax criminal laws, or to federal law enforcement and
intelligence agencies to combat terrorism.
The time needed to complete and file Form 637 “V” Questionnaire will vary depending on individual
circumstances. The estimated average time is 1 hour and 5 minutes.

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

“X” QUESTIONNAIRE

(Revision 01-21-2015)

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.

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

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

Home Port

Capacity

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

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

________________________________________________________________________________________
Privacy Act and Paperwork Reduction Act Notice. We ask for the information on Form 637 “X”
Questionnaire to carry out the Internal Revenue laws of the United States. We need it to figure and collect the
right amount of tax. Subtitle D of the Internal Revenue Code, Miscellaneous Excise Taxes, imposes certain
excise taxes. Section 4101 requires certain persons to register for excise taxes on fuel, as imposed by
sections 4041 and 4081. Sections 4101, 4222, and 4682 allow certain other manufacturers, sellers, or
purchasers to register to be eligible for credits or to be exempt from the excise tax on taxable articles. If you
are required to register under section 4101 or if you elect to register for credits and/or exemption, you are
required to provide the information requested on this form. Failure to provide this information may subject
persons required to register to penalties, and may delay or prevent the processing of a voluntary registration
for credits or exemption; providing false information may subject you to penalties. Section 6109 requires you
to provide the requested identification numbers.
You are not required to provide the information requested on a form that is subject to the Paperwork
Reduction Act unless the form displays a valid OMB control number. Books or records relating to a form or its
instructions must be retained as long as their contents may become material in the administration of any
Internal Revenue law.
Generally, tax returns and return information are confidential, as required by section 6103. However, section
6103 allows or requires the IRS to disclose or give such information to the Department of Justice for civil and
criminal litigation; to cities, states, the District of Columbia, and U.S. commonwealths and possessions to
administer their tax laws; and to other countries under a tax treaty. We may also disclose this information to
federal and state agencies to enforce federal nontax criminal laws, or to federal law enforcement and
intelligence agencies to combat terrorism.
The time needed to complete and file Form 637 “X” Questionnaire will vary depending on individual
circumstances. The estimated average time is 55 minutes.

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

“Y” QUESTIONNAIRE

(Revision 01-21-2015)

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.

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

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.

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

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

Name:
Address:
City, State, Zip

EIN:
Registration No:
OMB No. 1545-0014

______________________________________________________________________________________________
Privacy Act and Paperwork Reduction Act Notice. We ask for the information on Form 637 “Y” Questionnaire to
carry out the Internal Revenue laws of the United States. We need it to figure and collect the right amount of tax. Subtitle
D of the Internal Revenue Code, Miscellaneous Excise Taxes, imposes certain excise taxes. Section 4101 requires
certain persons to register for excise taxes on fuel, as imposed by sections 4041 and 4081. Sections 4101, 4222, and
4682 allow certain other manufacturers, sellers, or purchasers to register to be eligible for credits or to be exempt from
the excise tax on taxable articles. If you are required to register under section 4101 or if you elect to register for credits
and/or exemption, you are required to provide the information requested on this form. Failure to provide this information
may subject persons required to register to penalties, and may delay or prevent the processing of a voluntary
registration for credits or exemption; providing false information may subject you to penalties. Section 6109 requires you
to provide the requested identification numbers.
You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act
unless the form displays a valid OMB control number. Books or records relating to a form or its instructions must be
retained as long as their contents may become material in the administration of any Internal Revenue law.
Generally, tax returns and return information are confidential, as required by section 6103. However, section 6103
allows or requires the IRS to disclose or give such information to the Department of Justice for civil and criminal
litigation; to cities, states, the District of Columbia, and U.S. commonwealths and possessions to administer their tax
laws; and to other countries under a tax treaty. We may also disclose this information to federal and state agencies to
enforce federal nontax criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism.
The time needed to complete and file Form 637 “Y” Questionnaire will vary depending on individual circumstances. The
estimated average time is 1 hour and 20 minutes.

File Type	application/pdf
Author	Jackson John M
File Modified	2015-01-30
File Created	2015-01-30