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T ONLY FORM 4776 (REV. 11-2005) ULTIMATE VENDOR NAME TELEPHONE NUMBER ADDRESS Print Form DLN P.O. BOX FEIN OR SOCIAL SECURITY NUMBER CITY STATE ZIP PRODUCT CODE 065 Gasoline 123 Alcohol 124 Gasohol 125 Aviation Gasoline 130 Jet Fuel 142 Kerosene 072 Dyed Kerosene 160 Diesel Fuel 228 Dyed Diesel Fuel SALES INFORMATION Federal Government Agency 284 Bio-Diesel Undyed B100 285 Soy Oil 290 Bio-Diesel Dyed B100 Date of Sale 122.

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How to fill out the Brtgpk online

This guide will help you accurately complete the Brtgpk form, which is essential for obtaining motor fuel without paying tax for sales to the U.S. Federal Government. By following these step-by-step instructions, you will be able to efficiently navigate the online filling process and ensure your documentation is correct.

Follow the steps to successfully fill out the Brtgpk form online.

  1. Press the ‘Get Form’ button to access the Brtgpk online. This will open the form in an editable format.
  2. In the 'Ultimate Vendor Name' field, enter the full name of the ultimate vendor. This is the individual or company that will be purchasing the fuel.
  3. Fill in the 'Telephone Number' and 'Address' fields with the appropriate contact information for the ultimate vendor.
  4. Provide either the FEIN (Federal Employer Identification Number) or the Social Security number in the designated field to uniquely identify the vendor.
  5. Complete the 'Sales Information' section by writing the name of the federal government agency that will be using the fuel.
  6. Enter the 'Date of Sale'. Ensure this date corresponds to the purchase transaction.
  7. Select the 'Product Type' from the list provided, denoting which type of fuel is being purchased.
  8. Indicate the 'Number of Gallons' to specify the volume of fuel sold.
  9. Ensure you review the certification statement. By signing, you acknowledge the truth of the statement regarding the use of the certificate.
  10. Provide your printed name and sign the form in the designated 'Authorized Signature of Ultimate Vendor' field.
  11. Enter the date of your signature.
  12. If applicable, complete the fields for any intermediate vendors involved in the transaction. Provide their FEIN, Address, City, State, Zip, and signatures as necessary.
  13. After verifying all information is accurate and complete, you can save, download, print, or share the form as needed.

Complete your Brtgpk form online today to ensure compliance and efficiency in your motor fuel purchases.

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