Form ATF F 5070.1 ATF F 5070.1 Prevent All Cigarette Trafficking (PACT) Act Registratio

OMB No. 1140-0098 (xx/xx/xxxx)

U.S. Department of Justice
Bureau of Alcohol,Tobacco, Firearms and Explosives

Prevent All Cigarette Trafficking (PACT) Act
Registration Form

Any person who sells, transfers, or ships for profit cigarettes or smokeless tobacco in interstate commerce, whereby such cigarettes or smokeless
tobacco are shipped into a State, locality, or Indian country of an Indian tribe taxing the sale or use of cigarettes or smokeless tobacco or who
advertises or offers cigarettes or smokeless tobacco for such a sale, transfer, or shipment shall first file with the Attorney General of the United
States and with the tobacco tax administrators of the State and place into which such shipment is made, advertised, or offer is
disseminated.
Section I - Principal Business Information
1. Name of Person (See Definition #1)

2. Name of Person (If an Individual) (Last, first, middle)
Last
First

3. Trade Name(s)

Middle

4. Principal E-Mail Address

6. Telephone Number for Principal
Place of Business

7. Principal Website Address

AF
T

5. Address of Principal Place of Business

Section II - Additional Places of Business

8a. Name of Additional Place of Business

9a. Website Address for Additional Place of Business

10. Address of Additional Place of Business
a. Street Address

City

8b. Name of Additional Place of Business

Zip Code

State

R

9b. Website Address for Additional Place of Business

10. Address of Additional Place of Business

City

D

b. Street Address

Zip Code

State

8c. Name of Additional Place of Business

City

11b. Telephone Number at
Additional Location

9c. Website Address for Additional Place of Business

10. Address of Additional Place of Business
c. Street Address

11a. Telephone Number at
Additional Location

State

Zip Code

11c. Telephone Number at
Additional Location

Section III - Agent Authorized to Accept Service
12a. Name of Agent Authorized to Accept Service on Behalf of the Person (Person or Business Entity)
13a. Address of Authorized Agent

14a. Telephone Number of Authorized Agent

12b. Name of Agent Authorized to Accept Service on Behalf of the Person (Person or Business Entity)
13b. Address of Authorized Agent

14b. Telephone Number of Authorized Agent

NOTE: In addition to registering with the Bureau of Alcohol, Tobacco, Firearms and Explosives, the PACT Act also requires a person to register
with each State tobacco tax administrator in which the person sells and/or advertises cigarettes and/or smokeless tobacco products.
ATF Form 5070.1
Revised ( )

Definitions
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. 450b(e)) or as listed pursuant to section 104 of the Federally Recognized Indian Tribe List Act of 1994
(25 U.S.C. 479a-l).
Instructions
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 principal place of business.

6.

Provide the telephone number for the principal place of business.

7.

Provide the website for the principal 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).

AF
T

1.

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.

R

13a. Provide the address of the agent authorized to accept service.

14a. Provide the telephone number of the agent authorized to accept service.

D

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 Alcohol and Tobacco.
Privacy Act Notice

1. Authority: Public Law No. 111-154, 15 U.S.C. § 376(a) (1) authorizes the collection of this information.
2. Purpose: ATF will use this information to create a database of all registered delivery sellers of tobacco products.
3. Routine Uses: The information will be used by ATF personnel and contractors, state and local government or other agents who need the information
to assist in activities related to criminal investigations or certain regulatory enforcement activities. Additionally, ATF may share the information upon
request with other law enforcement or other government agencies, as necessary to investigate and prosecute crimes, or pursuant to its published
Privacy Act system of records notice.
4. Disclosure: Information requested shall be disclosed in accordance with 15 U.S.C. § 376(a) (1) “[a]ny person who sells, transfers, or ships for profit
cigarettes or smokeless tobacco in interstate commerce, whereby such cigarettes or smokeless tobacco are shipped into a State, locality, or Indian
country of an Indian tribe taxing the sale or use of cigarettes or smokeless tobacco, or who advertises or offers cigarettes or smokeless tobacco for such
a sale, transfer, or shipment.”
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 number.
ATF Form 5070.1
Revised (
)