Form 637 C Questionnaire OMB_Rev_Feb_2022

Name:		EIN:
Address:		637 Reg No.:
City, State, Zip:		OMB No.:	1545-1835

In addition to the Form 637 General Questionnaire, please answer the following questions specific to this activity. (Attach additional sheets, if needed.)

Activity Letter C - 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 nonprofit educational organizations or (4) as supplies for vessels or aircraft.

Registration allows a buyer to purchase taxable tires from the manufacturer tax-free.

"C" QUESTIONNAIRE

1. Does your business qualify for the Form 637 “C” Registration?

☐ Yes ☐ No

• If yes, please complete questions below and return this form.

• If no, please sign the statement below, date, and return this form.

I request my Form 637 _“C_” Registration be denied or revoked as I am no longer engaged in this activity.

____________________________________ __________________

Printed Name Title

____________________________________ __________________

Signature Date

Note: This request must be signed by a person with authority to bind the applicant or registrant. Refer to Form 637, Application for Registration (For Certain Excise Tax Activities), General Instructions, under the Signature section for additional guidance.

1. Does your business manufacture and sell any articles in which taxable tires are attached?

☐ Yes ☐ No

If yes, list the articles manufactured and sold.

3. 
   
   

   
   
   

   
   
   

   List the name and address of supplier, size, and weight of taxable tires that will be purchased excise tax- exempt.

   Name and Address of Supplier	Size	Weight

4. List the name and address of organizations or businesses with which your business intends to have tax-exempt sales.

5. 
   
   

   
   
   

   
   
   

   List the name and address of all locations where heavy tires are sold at retail?

6. 
   
   

   
   
   

   
   
   

   Provide the name and address of any brokers used to export tires subject to excise tax.

7. 
   
   

   
   
   

   
   
   

   Please describe the proof of export the company plans to obtain to verify the articles were exported.

8. 
   
   

   
   
   

   
   
   

   List the name and phone number of a person whom we can contact about this application/registration.

Form 637 C Questionnaire 2 Revised Feb 2022