Form Mft-7a - Application For Wholesale Dealer'S License - 1997 Page 2
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212. List the names and addresses of all persons from whom applicant purchased fuels, and list products purchased.
NAME and ADDRESS
PRODUCT
______________________________________________________________________
________________________________________
______________________________________________________________________
________________________________________
______________________________________________________________________
________________________________________
13. Give name, title, address and telephone number of person charged with the duty of filing motor fuels tax reports and location where reports are prepared
and records kept.__________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
14. Give name, title and address of agent in New Jersey or registered New Jersey agent on whom service may be made (must be documented by letter from
agent)___________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
15. Average monthly fuels sales during the preceding twelve months _____________________________________ gallons.
16. Average monthly fuels use during preceding twelve months ______________________________________ gallons.
17. Number of diesel vehicles operated ____________________________________.
18. Name of common carriers utilized to transport fuels_______________________________________________________________________________
________________________________________________________________________________________________________________________
19. Provide detailed description of business _______________________________________________________________________________________
________________________________________________________________________________________________________________________
NOTE: Question 14 must be completed by out-of-state businesses.
The undersigned applicant states, (under penalty of perjury), that all the information contained in this application is true and accurate in every
particular.
_________________________________________________________
___________________________________________________
Name of Applicant
Signature of Owner, Partner or Officer
___________________________________________________
Title
Date
The information submitted will assist this office in the processing of your license request.
The Division of Taxation reserves the right to conduct a thorough investigation prior to issuing this license.
FOR DIVISION USE ONLY
License No. _______________________________________________
Investigation initiated __________________________________
Effective Date ______________________________________________
Investigation completed ________________________________
Approved _________________________________________________
Recommendations: ____________________________________________________________________________________________________
MFT-7A
(12-97)
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