ATF E-Form 5070.1A
Revised April 2011
U.S. Department of Justice
Bureau of Alcohol, Tobacco, Firearms and Explosives
Prevent All Cigarette Trafficking (PACT) Act
Registration Form (Continuation Sheet)
OMB No. 1140-0098 (07/31/2020)
Section II - Additional Places of Business (Continued)
8d. Name of Additional Place of Business 9d. Website Address for Additional Place of Business
10. Address of Additional Place of Business
d. Street Address City State Zip Code
11d. Telephone Number at
Additional Location
8e. Name of Additional Place of Business 9e. Website Address for Additional Place of Business
10. Address of Additional Place of Business
e. Street Address City State Zip Code
11e. Telephone Number at
Additional Location
8f. Name of Additional Place of Business 9f. Website Address for Additional Place of Business
10. Address of Additional Place of Business
f. Street Address City State Zip Code
11f. Telephone Number at
Additional Location
8g. Name of Additional Place of Business 9g. Website Address for Additional Place of Business
10. Address of Additional Place of Business
g. Street Address City State Zip Code
11g. Telephone Number at
Additional Location
Section III - Agent Authorized to Accept (Continued)
12c. Name of Agent Authorized to Accept Service on Behalf of the Person (Person or Business Entity)
13c. Address of Authorized Agent 14c. Telephone Number of Authorized Agent
12d. Name of Agent Authorized to Accept Service on Behalf of the Person (Person or Business Entity)
13d. Address of Authorized Agent 14d. Telephone Number of Authorized Agent
12e. Name of Agent Authorized to Accept Service on Behalf of the Person (Person or Business Entity)
13e. Address of Authorized Agent 14e. Telephone Number of Authorized Agent
12f. Name of Agent Authorized to Accept Service on Behalf of the Person (Person or Business Entity)
13f. Address of Authorized Agent 14f. Telephone Number of Authorized Agent
12g. Name of Agent Authorized to Accept Service on Behalf of the Person (Person or Business Entity)
13g. Address of Authorized Agent 14g. Telephone Number of Authorized Agent
