(1) The business name, address, telephone number, mandatory social security number, birth date, and driver's license(s)/identification number(s) of the applicant;

(2) The names, addresses, and telephone numbers of principal creditors of the business, if any;

(3) The principal place of business and telephone number in California;

(4) The date of submission;

(5) Self-disclosure of any bankruptcy filings by owner, partner, or agent within the past four years;

(6) Self-disclosure of previous license revocation(s) or suspension(s), convictions for financial crimes as described in Section 1702.1(a)(5);

(7) A description of the business to be licensed.

(8) If the application is for an agent's license only, the name, address and telephone number of the person whom the agent represents and the signature of the person's authorized officer or principal endorsing the application;

(1) A list of any current licenses and/or licenses from the previous five years issued by the Department for the applicant;

(2) A list by an individual of any current licenses and/or licenses from the previous five years issued by the Department for a partner or affiliate of a partnership applicant;

(3) A list by an individual of any current licenses and/or licenses from the previous five years issued by the Department for any agent of the applicant;

(4) A signed acknowledgment that the applicant has been informed of the Department's authority to obtain financial information concerning the applicant from credit reporting agencies, creditors, or financial institutions;

(5) A signed acknowledgment that the applicant has been informed of the Department's authority to obtain criminal record information concerning the applicant or its agent(s);

(6) A signed acknowledgment that the applicant is required to abide by all provisions of Division 20, Chapters 6 and 7, of the Food and Agricultural Code, including section 56189, if any;

(7) A Schedule of Charges if the applicant is acting as a broker and/or commission merchant;

(8) Full payment of all fees required on the application;

(9) A list of California commodities handled;

(10) For Cash Buyers and Cash Buying Processors, a statement of understanding that all transactions shall be made in cash;

(11) A list of farm products creditors owed sums that are delinquent, if any, including their names, addresses, and amounts owed; and,

(12) A copy of the formal fictitious name statement for an applicant who notes a “doing business as” (d.b.a.). This is the statement on file with the county in which the applicant does business.