Form Gas-1262 - Motor Fuels Application - North Carolina Department Of Revenue - 2008 Page 11
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23Supplier Election (Tax at the Rack)
Suppliers may elect to collect North Carolina’s excise tax on imported fuel from out-of-state terminals. Once this election is made, suppliers must
collect excise taxes on all reportable petroleum products removed from out-of-state terminals which reflect North Carolina as the destination state on
the shipping documents.
31. Indicate the type of supplier license you are requesting.
Elective Supplier is required to be licensed in North Carolina and elects to collect motor fuel excise tax on fuel
imported from out-of-state terminals that have North Carolina as its destination.
Permissive Supplier is an out-of-state supplier that is not required to be licensed in North Carolina but elects to
be licensed and collect motor fuel excise tax on fuel imported from out-of-state terminals that have North Carolina
as its destination.
In-State Only Supplier is required to be licensed in North Carolina but does not elect to collect motor fuel excise
tax on fuel imported from out-of-state terminals that have North Carolina as its destination.
Distributor License
List Federal 637 Number (If applicable):
32. Do you maintain bulk storage facilities in North Carolina?
Yes
No
33. Where is your bulk storage located?
Above Ground
34. Fuel Storage Capacity:
Below Ground
35. If no bulk storage facility is owned, explain storage arrangements.
Yes
No
36. Do you plan to import petroleum products into North Carolina?
37. Indicate the type of petroleum products imported into North Carolina.
Gasoline
Undyed Kerosene
Aviation Gasoline
Alcohol
Low Sulfur Diesel
Dyed Kerosene
Ethanol
Propane
High Sulfur Diesel
Jet Fuel
Methanol
Undyed Biodiesel
Dyed Biodiesel
38. Indicate the means of transport for this imported product.
Seagoing Vessel/Barge
Transport Truck
Tank Wagon
Railroad Tank Car
Pipeline
Other - Describe
39. List the states from which you import petroleum products and your license number in those states. (Attach additional sheets if necessary.)
40. Estimate the number of taxable gallons that will be sold or used in North Carolina during an average month.
Dyed
Methanol
Gasoline
Kerosene
Low Sulfur
Jet Fuel
Alcohol
Diesel
High Sulfur
Aviation
Propane
Diesel
Gasoline
Undyed
Undyed
Ethanol
Biodiesel
Kerosene
Dyed
No
Yes
41. Do you plan to export petroleum products out of North Carolina?
Biodiesel
42. Indicate the type of petroleum products exported from North Carolina.
Gasoline
Undyed Kerosene
Aviation Gasoline
Alcohol
Low Sulfur Diesel
Dyed Kerosene
Ethanol
Propane
High Sulfur Diesel
Jet Fuel
Methanol
Undyed Biodiesel
Dyed Biodiesel
43. Indicate the means of transport for this exported product.
Seagoing Vessel/Barge
Transport Truck
Tank Wagon
Pipeline
Railroad Tank Car
Other - Describe
44. List the destination states for exported petroleum products and your license number in those states. (Attach additional sheets if necessary.)
Yes
No
45. Are you a shipper of record on one of the commercial pipelines serving North Carolina?
46. What other types of operations will you be engaged in?
Direct shipments
Other - Describe
Exchanges
Sales on consignment
Sell petroleum products
Trade petroleum products
Operate service stations
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