Form Rt 132 - Application For Motor Fuel Distributor License - Nh Road Toll Bureau - Fy2010 Page 2
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2Estimated monthly gallonage imported into New Hampshire: _________________________________ Gallons
Do you currently hold a Motor Fuel Distributor License in any other New England State?
Yes
No
If answer is “Yes”, please list the states and license numbers:_______________________________________
NEW HAMPSHIRE LOCATED BULK STORAGE FACILITIES*
Tank Location (Street, City/Town)
Capacity
Product Type
Owned or Leased
SIGNED BY:_____________________________________________ TITLE:______________________________
FOR (APPLICANT): ___________________________________________________________________________
∗
” "Storage facility" means a permanently affixed, enclosed space, used for the accumulation and
Per SAF-C 302.01, (a), (16):
subsequent distribution of motor fuel at the wholesale level. Storage facility does not include any product contained in a facility
that is attached to a pump used for retail sale to the public...”
RT 132 (REV 05/2009)
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