ATF E-Form 5070.1
Revised April 2011
1. Person - The term "person" means an individual, corporation, company, association, firm partnership, society, State government, local government, Indian
tribal government, governmental organization of such a government, or joint stock company.
2. Indian Tribe - The term "Indian tribe," "tribe," or "tribal," refers to an Indian tribe as defined in section 4(e) of the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 450(e)) or as listed pursuant to section 104 of the Federally Recognized Indian Tribe List Act of 1994 (25 U.S.C.
1. Provide the name of the "person" registering. Please refer to the definition of "person" provided.
2. Provide the "Name of the Person" if an individual is the registrant.
3. Provide all trade names used by the Person.
4. Provide the principal e-mail associated with the Person.
5. Provide the address of the principle place of business.
6. Provide the telephone number for the principal place of business.
7. Provide the website for the principle place of business.
8a. Provide the name of the additional place of business (additional blocks are provided if needed).
9a. Provide the website address for the additional place of business (if any).
10a. Provide the address of the additional place of business.
11a. Provide the telephone number of the additional place of business.
12a. Name of the agent authorized to accept service on behalf of the person. This can be an individual or a business entity. The person must provide an agent
or agents authorized to accept service in each of the states where the person does business. If there are multiple authorized agents, the person must list an
authorized agent for each state in which the person does business. Please indicate which state(s) each agent covers in parentheses after their name. Ex.
Authorized Agent Inc., (New York). Additional blocks are provided if needed.
13a. Provide the address of the agent authorized to accept service.
14a. Provide the telephone number of the agent authorized to accept service.
NOTICE: Please use ATF Form 5070.1A, to report additional information needed to complete your registration in accordance with the PACT Act. ATF
Form 5070.1A can be found at www.atf.gov under the Tobacco Diversion tab
Paperwork Reduction Act Notice
The information required on this form is in accordance with the Paperwork Reduction Act of 1995. The purpose of the information is to register delivery
sellers of cigarettes and/or smokeless tobacco products with the Attorney General in order to legally continue to sell and/or advertise these tobacco products.
The information is mandatory as required by P.L. 111-154.
The estimated average burden associated with this collection is 1 hour per respondent or recordkeeper, depending on individual circumstances. Comments
about the accuracy of this burden estimate and suggestions for reducing it should be directed to Reports Management Officer, Document Services, Bureau of
Alcohol, Tobacco, Firearms and Explosives, Washington, DC 20226.
An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control