Form 637 V 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 V - Manufacturer, importer, or buyer of ozone-depleting chemicals (ODC’s) for export.

Registration allows manufacturer or importer to make a tax-free sale of ODCs that are sold for export or for resale by the purchases to a second purchaser for export in a qualifying sale for export.

Registration also allows the seller (purchaser that acquired ODCs in a qualifying sale for export) to resell ODCs tax-free in a qualifying resale for export.

“V” QUESTIONNAIRE

1. Does your business qualify for the Form 637 “V” 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 _“V” 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. List the ozone-depleting chemicals your business import or manufacture for export.

2. 
   
   

   
   
   

   
   
   

   
   
   

   
   
   

   List the name and address of companies from which your business buys ozone- depleting chemicals.

3. 
   
   

   
   
   

   
   
   

   
   
   

   
   
   

   List the products your business manufacture, import, or buy for export.

4. 
   
   

   
   
   

   
   
   

   
   
   

   
   
   

   List the number of pounds for each ozone-depleting chemical exported in this calendar year and an estimate for the next calendar year.

5. 
   
   

   
   
   

   
   
   

   
   
   

   List your business export locations.

6. 
   
   

   
   
   

   
   
   

   
   
   

   List your business production allowance, export allowance, and export percentage as set by the Environmental Protection Agency.

7. 
   
   

   
   
   

   
   
   

   How does your business calculate the amount of credit or refund related to an exported article that contains ozone-depleting chemicals?

8. 
   
   

   
   
   

   
   
   

   
   
   

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

9. 
   
   

   
   
   

   
   
   

   
   
   

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

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

Form 637 V Questionnaire 2 Revised Feb 2022