Form Ft-960 - Uniform Manifest For Interstate (Importation) Movements Of Motor Fuel And Diesel Motor Fuel Page 2

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Page 2 of 2 FT-960 (9/11)
Part 4a — First off-loading
16. Terminal or site where fuel is to be off-loaded (name and address)
17. Date
and time of delivery
(mm/dd/yy)
/
/
18. Account into which fuel is to be delivered (name and address or account number)
19. Number of gallons of each type of fuel to be off-loaded
Motor fuel
Diesel motor fuel
Regular unleaded ............................
gal.
Diesel ................................................
gal.
Mid-grade unleaded ........................
gal.
Kerosene ...........................................
gal.
Premium unleaded ..........................
gal.
No. 2 fuel oil ......................................
gal.
Other (type
)
gal.
Other (type
)
gal.
Part 4b — Second off-loading
16. Terminal or site where fuel is to be off-loaded (name and address)
17. Date
and time of delivery
(mm/dd/yy)
/
/
18. Account into which fuel is to be delivered (name and address or account number)
19. Number of gallons of each type of fuel to be off-loaded
Motor fuel
Diesel motor fuel
Regular unleaded ............................
gal.
Diesel ................................................
gal.
Mid-grade unleaded ........................
gal.
Kerosene ...........................................
gal.
Premium unleaded ..........................
gal.
No. 2 fuel oil ......................................
gal.
Other (type
)
gal.
Other (type
)
gal.
Part 4c — Third off-loading
16. Terminal or site where fuel is to be off-loaded (name and address)
17. Date
and time of delivery
(mm/dd/yy)
/
/
18. Account into which fuel is to be delivered (name and address or account number)
19. Number of gallons of each type of fuel to be off-loaded
Motor fuel
Diesel motor fuel
Regular unleaded ............................
gal.
Diesel ................................................
gal.
Mid-grade unleaded ........................
gal.
Kerosene ...........................................
gal.
Premium unleaded ..........................
gal.
No. 2 fuel oil ......................................
gal.
Other (type
)
gal.
Other (type
)
gal.

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