Form 720-TO (Rev. 9-2010)
Terminal operator name as shown on Form 720-TO
(a)
Carrier
name
(b)
Carrier
EIN
(c)
Vessel official number
(required when mode code is
B, S, IB, IS, EB, or ES)
(d)
Document
date
(e)
Document
number
(f)
Net
gallons
Page 3
For the month ending (enter MM/DD/YYYY)
TCN
EIN
Totals. Add all amounts in columns (f) and (g) for each PC, DS, or MC. If there are two MCs for a product destined for one
state, or if a product is destined for two states, then two Schedules B and totals are required. If there is more than one Schedule
B for a PC, DS, or MC, add the amounts from each schedule and enter the result on the last page of Schedule B for each
different PC, DS, or MC. Do not enter page subtotals. Enter the amount from column (f) for each PC on Form 720-TO, Part III,
line 4, in the column for the applicable PC
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Terminal Operator Disbursements by Position Holder
Schedule B
Form 720-TO (Rev. 9-2010)
Corrected
Void
Page
For more than one Schedule B, for each different PC, DS, or
MC, number each sheet. For example, 1 of 4, 2 of 4, etc.
of
Enter in the columns below the information requested for the PC on line 1 above.
Position Holder name. Enter one name per page.
PH EIN
PH Form 637 registration number
(g)
Gross
gallons
Complete lines 1 through 4 for each PC.
Product Code (PC). Enter the PC (see instructions). A separate schedule is required for each PC
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Destination State (DS). Enter the DS for each PC (see instructions). A separate schedule is required for each PC by state. PC 167 destined for Virginia
(VA) and Maryland (MD) requires two schedules
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Mode Code (MC). Enter the MC (see instructions) for each PC for each DS. PC 167 destined for VA by truck and rail and destined for MD by truck and
rail would require four separate schedules: (1) PC 167, VA, rail; (2) PC 167, VA, truck; (3) PC 167, MD, rail; and (4) PC 167, MD, truck
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Example. ABC Terminal is preparing Schedule B for disbursements made by position holder XYZ. XYZ disburses gasoline (PC 065), diesel fuel #2 low sulphur undyed
(PC 167), and jet fuel (PC 130) during the month destined for two states by truck. ABC must prepare six Schedules B to report XYZ’s transactions (3 PCs x 2 DSs). A
further breakdown by MC is not needed because only truck was used.
5(f)
5(g)
1
2
3
4
5
1
2
3