Form Cot/fed-306 - Application For Registration Of Exchange Agreement, Specifications And Additives

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COMPTROLLER OF MARYLAND
FIELD ENFORCEMENT DIVISION
P.O. BOX 2397, ANNAPOLIS, MD 21404-2397
410-260-7388, 888-674-0017 (Toll-Free), 410-974-5564 (Fax)
APPLICATION FOR REGISTRATION OF EXCHANGE AGREEMENT, SPECIFICATIONS AND ADDITIVES
(In accordance with Business Regulation Article, §10-305 through §10-309 and regulations pertaining thereto.)
Name of Manufacturer or Refiner Acquiring Product
Street Address
Federal ID #
Phone #
City
State
Zip
Annual
Additional
Emergency
Period of Agreement:
From
To
INFORMATION REQUIRED FOR EACH GRADE OF GASOLINE AND MIDDLE DISTILLATE FUELS
Attach refinery specifications for each grade of product acquired via this exchange, as well as for each grade of product
sold in Maryland.
List exchange partner from whom products are acquired, point of acquisition and the individual products acquired.
(A separate sheet is required for each source-point serving Maryland.)
Exchange Partner
Source Point City
Products Acquired by Type and Grade
Additives introduced (by product and grade) after receipt in Maryland, or at time of shipment.
Additive Designation
Product
Grade
How Injected, At What Point and Amount
File this information annually by December 31 to reflect the next year's established activity. File additional exchange
agreements as they occur throughout the year, using this form. Report deletions as they occur, by letter, to the Field
Enforcement Division.
I certify under the penalties of perjury that this EXCHANGE AGREEMENT has been examined by me and to the best
of my knowledge is true, correct and complete, covering the exchange shown hereon by the parties indicated.
MANUFACTURER OR REFINER ACQUIRING PRODUCT
Signature
Date
Name and Title (please print)
EXCHANGE PARTNER
Name of Person, Firm or Corporation
Street Address
Federal ID #
Phone #
City
State
Zip
Signature
Date
Name and Title (please print)
COT/FED-306 Rev. 2/10

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