Form Dr 7064 - Fuel Distributors License Application Page 5
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7V. Colorado Business Locations - P rovide the following information for each business location in Colorado in which you
have an ownership. Attach additional copies of sheets if necessary.
Trade Name/Doing Business As
Street Address
City
State
ZIP
Blending Facility
Storage Facility
Facility
Service Station
Wholesaler
Broker
Terminal
IRS Terminal code:___________
Type of Fuel Stored and Capacity at Location (gallons)
Duplicate fuel
Distributor License
Gasoline ___________
Gasohol _________
Special Fuel __________
Aviation Gasoline ____________
Required
Aviation Jet Fuel _______
Other _________________________________________________________________
Check Box
Trade Name/Doing Business As
Street Address
City
State
ZIP
Blending Facility
Storage Facility
Facility
Service Station
Wholesaler
Broker
Terminal
IRS Terminal code:___________
Type of Fuel Stored and Capacity at Location (gallons)
Duplicate fuel
Distributor License
Gasoline ___________
Gasohol _________
Special Fuel __________
Aviation Gasoline ____________
Required
Aviation Jet Fuel _______
Other _________________________________________________________________
Check Box
Trade Name/Doing Business As
Street Address
City
State
ZIP
Blending Facility
Storage Facility
Facility
Service Station
Wholesaler
Broker
Terminal
IRS Terminal code:___________
Type of Fuel Stored and Capacity at Location (gallons)
Duplicate fuel
Distributor License
Gasoline ___________
Gasohol _________
Special Fuel __________
Aviation Gasoline ____________
Required
Aviation Jet Fuel _______
Other _________________________________________________________________
Check Box
Trade Name/Doing Business As
Street Address
City
State
ZIP
Blending Facility
Storage Facility
Facility
Service Station
Wholesaler
Broker
Terminal
IRS Terminal code:___________
Type of Fuel Stored and Capacity at Location (gallons)
Duplicate fuel
Distributor License
Gasoline ___________
Gasohol _________
Special Fuel __________
Aviation Gasoline ____________
Required
Aviation Jet Fuel _______
Other _________________________________________________________________
Check Box
Trade Name/Doing Business As
Street Address
City
State
ZIP
Blending Facility
Storage Facility
Facility
Service Station
Wholesaler
Broker
Terminal
IRS Terminal code:___________
Type of Fuel Stored and Capacity at Location (gallons)
Duplicate fuel
Distributor License
Gasoline ___________
Gasohol _________
Special Fuel __________
Aviation Gasoline ____________
Required
Aviation Jet Fuel _______
Other _________________________________________________________________
Check Box
(Page 3)
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Parent category: Financial