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The 9-page form requires these sections: Section 1A Applicant Information: Full legal name of applicant (permit issued in this name) Business name (D/B/A) Mailing address and contact information FEIN number and Department of State document number (if applicable) Section 2A-2D Permit Information: Choose permit type: RTPD (tobacco and nicotine products) or RNPD (nicotine products only) Business location address for each permit requested Methods of sale: over the counter, vending machine, internet, mobile, or smoking pipes/devices Include website address for internet sales or VIN number for mobile sales Permit applicant (if sole proprietorship) All officers of the applicant Anyone owning more than 10% ownership interests

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