Form Com/mft105 - Application For Wholesale Purchaser/consumer Motor Fuel Inspection & Testing

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Comptroller of Maryland
P.O. Box 1751
MATT Regulatory Division
Annapolis, MD 21401-1751
Motor Fuel Tax
410-260-7215
1-800-784-0142
Application For Wholesale Purchaser/Consumer
Motor Fuel Inspection & Testing
Authority: Business Regulation Article, Title 10, Subtitle 3, Annotated Code of Maryland
1.
Applicant’s legal name
Trade name
Business address
City
State
9-digit ZIP code
County
Business telephone number
(
)
2.
–
–
–
Federal Identification Number
Social Security Number
3. Type of ownership:
 Sole proprietorship
 Non-MD corporation closed
 Partnership
 Unincorporated association
 Non-profit corporation
 Governmental
 Maryland corporation regular
 Fiduciary
 Maryland corporation closed
 Cooperative
 Non-MD corporation regular
 Limited liability co. (LLC)
4. Sole proprietors indicate home address and telephone number if different than Item 1. If applicant is a
corporation, partnership or limited liability company, information requested below must be provided for
all officers, partners, or members, and resident general agent and attorney-in-fact.
Social Security
Home Telephone
Name
Number
Home address
Number
5. Type of business
6. Do you sell any motor fuel? 
Yes  No If yes, indicate.
 Gasoline
 Fuel oil
 Turbine
 Diesel
 Propane
 Natural gas
 Kerosene
Complete important supplier/storage information on reverse side
COM/MFT105 Rev. 3/08

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