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Department, the following: Such distributor shall be issued, without charge, a permit to collect such tax in such manner, and subject to such reasonable regulations and agreements as the Department shall prescribe (A) a statement that the applicant will fully comply with the Tobacco Products Manufacturers' Escrow Enforcement Act of 2003; and (B) the following information: (i) the name and address of the applicant; (ii) the address of the location at which the applicant proposes to engage in business; and (iii) such other additional information as the Department may reasonably require by its rules. When so authorized, it shall be the duty of such distributor to collect the tax upon all cigarettes which the distributor he delivers (or causes to be delivered) within this State to licensed distributors, in the same manner and subject to the same requirements as a distributor maintaining a place of business within this State. Such permit shall be in such form as the Department may prescribe and shall not be transferable or assignable. (2) The following are ineligible to receive a distributor's permit under this subsection Act: (A) (1) a person who is not of good character and reputation in the community in which the person he resides; the Department may consider prior conviction SB3019 Enrolled LRB104 20255 HLH 33706 b Public Act 104-0468