Form 720-Cs - Carrier Summary Report
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3720-CS
OMB No. 1545-1733
Form
Carrier Summary Report
(Rev. September 2010)
Department of the Treasury
For the month ending
, 20
.
Corrected
Void
Internal Revenue Service
Part I
Carrier
Company name
Employer identification number (EIN)
Address (number, street, room or suite number)
Form 637 registration number
City, state, and ZIP code (Foreign addresses, include province and postal code as appropriate. Do not abbreviate country name.)
Contact person
Daytime telephone number
Fax number
Email address
Part II
Transactions for the Month
Net Gallons (attach additional schedule(s) if needed)
Enter the transactions for the period on Schedules A and B, then complete
lines 1 and 2 for each product code (PC) (see instructions).
(a)
(b)
(c)
(d)
PC:
PC:
PC:
PC:
1
Total receipts. Enter the total net gallons from
Schedule(s) A, column (g), by PC. If you have
receipts from more than one facility for a PC,
add the amounts from each facility's Schedule
A and enter the combined total by PC.
2
Total deliveries. Enter the total net gallons
from Schedule(s) B, column (g), by PC. If you
have deliveries to more than one facility for a
PC, you must add the amounts from each
facility’s Schedule B and enter the combined
total by PC.
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my
knowledge and belief, it is true, correct, and complete.
Signature
Title, if applicable
Date
▶
▶
▶
Type or print your name below signature.
720-CS
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Form
(Rev. 9-2010)
Cat. No. 73073H
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