Form 905 - Monthly Retailer Report

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905
FORM
MONTHLY RETAILER REPORT
Company Name :
Reporting Period :
License Number :
Fed TIN# :
Page No. :
Bill of
Loading
Delivery
Navajo Nation
Unloading
Type of Fuel *
Number of
Lading
Point
Date
Manifest Number
Point
G
D
R
A
H
Gallons
Total Net Gallons :
* Key: G=Gasoline; D=Diesel; R=Dyed Diesel (Used in Motor Vehicles); A=Aviation; H=Heating
ONTC
FET - Form 905
Revised: 2/12/02

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