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but shall be deemed to be sufficiently licensed or registered by virtue of his being licensed or registered under the Cigarette Tax Act. Every distributor maintaining a place of business in this State, if not required to procure a license or allowed to obtain a permit as a distributor under the Cigarette Tax Act, shall make an a verified application to the Department, by electronic means, in (upon a form prescribed and furnished by the Department) for a license to act as a distributor under this Section. Each applicant for a license under this Section shall furnish to the Department in a form signed and verified by the applicant under penalty of perjury, in an electronic format established by the Department, the following: Act. In completing such application, the applicant shall furnish such information as the Department may reasonably require (1) a statement that the applicant will fully comply with the Tobacco Products Manufacturers' Escrow Enforcement Act of 2003; and (2) the following information: (A) the name and address of the applicant; (B) the address of the location at which the applicant proposes to engage in business as a distributor of cigarettes in this State; and (C) such other additional information as the Department may reasonably require by its rules. The annual license fee payable to the Department for the SB3019 Enrolled LRB104 20255 HLH 33706 b Public Act 104-0468