Form Carrier Summary Report OMB No. 1545-1733

(Rev. January 2004)

Department of the Treasury

Internal Revenue Service For the month ending , 20 .

Company name Employer Identification Number (EIN)

Address (number, street, room or suite number)

Transactions for the Month

Total carrier receipts. Enter the total

net gallons from Schedule(s) A, column

(f), by product code. If you have

receipts from more than one terminal

for a product code, you must add the

amounts from each terminal’s

Schedule A and enter the combined

total by product code here.

For Privacy Act and Paperwork Reduction Act Notice, see page 5 of the instructions. Form 720-CS (Rev. 1-2004)

1

2 Total carrier deliveries. Enter the total

net gallons from Schedule(s) B, column

(f), by product code. If you have

deliveries to more than one terminal for

a product code, you must add the

amounts from each terminal’s

Schedule B and enter the combined

total by product code here.

Under penalties of perjury, I declare that I have examined this return and accompanying schedules, and, to the best of my knowledge and belief, they are true,

correct, and complete.

Enter the transactions for the period on Schedules A and B, then

complete lines 1 and 2 for each product code (PC). See page 6 of

the instructions for the product codes.

(a)

Cat. No. 73073H

720-CS

Part I

Part II

City, state, and ZIP code (Foreign addresses, include province and postal code as appropriate. Do not abbreviate country name.)

Contact person

Carrier

Daytime telephone number FAX number Email address

(b) (c) (d)

Net Gallons (attach additional schedule(s) if needed)

PC: PC: PC: PC:

() ()

Corrected Void

Signature  Title, if applicable  Date 

Type or print your name below signature.

Form 637 Registration Number
For the month ending (enter MM/DD/YYYY)

n (f) for each different PC. If there is more than one page for a PC, add the amounts from each page and enter the

 A for that PC. Do not enter page subtotals. Also, include the amount from column (f) on Form 720-CS, line 1, in the



Form 720-CS (Rev. 1-2004)

product code from page 6 of the

 required for each PC. 

 From a Terminal

(b) (c) (d) (e) (f)

Consignor

name

Mode of

transportation

Document

date

Document

number

Net

gallons

Page 2

Form 637 Registration Number

Corrected Void

EIN

e A for each terminal. TCN of terminal

For more than one Schedule A, for each different PC, number eachsheet. For example, 1 of 4, 2 of 4, etc.Page of

3

formation requested for the PC on line 1 above.

1
For the month ending (enter MM/DD/YYYY)

n (f) for each different PC. If there is more than one page for a PC, add the amounts from each page and enter the

 B for that PC. Do not enter page subtotals. Also, include the amount from column (f) on Form 720-CS, line 2, in the



Form 720-CS (Rev. 1-2004)

product code from page 6 of the

 required for each PC 

s to a Terminal

(b) (c) (d) (e) (f)

Consignor

name

Mode of

transportation

Document

date

Document

number

Net

gallons

Page 3

Form 637 Registration Number

Corrected Void

EIN

e B for each terminal. TCN of terminal

For more than one Schedule B, for each different PC, number eachsheet. For example, 1 of 4, 2 of 4, etc.Page of

1

3

formation requested for the PC on line 1 above.