Form 117 - Application For License(S) Of Motor Fuels
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1
2Form 117
Revised 3-2013
State of Oklahoma - Oklahoma Tax Commission
Application for License(s) of Motor Fuels
Type of Ownership:
Sole Proprietor (one owner)
Partnership (two or more owners)
LLP
LLC
Corporation
Other (explain) ________________________________________________________________
I hereby make application for the following license(s):
Producer-Ethyl Alcohol (Ethanol) (Fuel Vendor)
Supplier/Permissive Supplier
(Please complete section that pertains to this license)
Terminal Operator
Producer-Biodiesel (Fuel Vendor)
Exporter
(Please complete section that pertains to this license)
Transporter
Compressed Natural Gas-Retailer (Fuel Vendor)
Occasional Importer
Compressed Natural Gas-Wholesaler (Fuel Vendor)
Bonded Importer
Compressed Natural Gas-Consumer/End User (Fuel Vendor)
Tank Wagon Operator - Importer
Fuel Blender (Fuel Vendor)
(Please complete section that pertains to this license)
Eligible Purchaser
Fuel Vendor
Wholesaler (Fuel Vendor)
Retailer (Fuel Vendor)
Please print or type the information below:
Mailing address (For all correspondence):
FEI/Social Security Number
Street
Owner, Partnership, or Corporate Charter Name
City, State, Zip
Physical location business (No P.O. Box):
Trade Name (Doing business as)
Street
Business Phone Number
Fax Number
City, State, Zip
(If more than one location, attach separate sheet)
Name(s) of business partners, or officers:
Social Security Number
Name/Title
Home Mailing Address
Continued on page 2
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