(1) The applicant's name, address, telephone number, electronic mail address and Internet website.

(2) The address of each location in this Commonwealth where the applicant will provide debt management services.

(3) The name and address of each owner, officer, director or principal of the applicant.

(4) The name and address of the applicant's agent for service of process in this Commonwealth.

(5) A description of the ownership interest of any officer, director, agent or employee of the applicant in an affiliate or subsidiary of the applicant or in any other business entity that will provide any service to the applicant or to a consumer relating to the applicant's provision of debt management services.

(6) A list of other states in which the applicant engages in the business of providing debt management services, including any relevant license or registration number and information regarding whether a license or registration in another state has ever been suspended or revoked.

(7) The audited financial statement from the applicant's most recent fiscal year, including an audit opinion from an independent certified public accountant.

(8) A copy of a liability or fidelity insurance policy that insures against dishonesty, fraud, theft or other malfeasance on the part of the applicant's employees, officers, directors or principals.

(9) A copy of the applicant's standard debt management services agreement.

(10) Information regarding the applicant's trust account, including the name and address of the FDIC-insured depository institution where the account is located and the number of the account.

(11) Information regarding the number of the applicant's credit counselors and supervisors or managers with direct supervisory duties of credit counselors who perform the consumer education program who are certified by an independent certifying organization acceptable to the department and a plan to ensure that any of the credit counselors and supervisors or managers with direct supervisory duties of credit counselors who perform the consumer education program who are not certified become certified within six months of the issuance date of the license. A licensee shall notify the department of any change in status regarding the licensee's certified credit counselors, supervisor or managers with direct supervisory duties of credit counselors within ten days of the change.

(12) Evidence that the applicant is accredited by an independent accrediting organization acceptable to the department.

(13) A penal bond meeting the requirements of section 7.¹

(14) A nonrefundable fee of $2,000.

(15) A description of the consumer education program that the applicant provides or intends to provide to consumers along with copies of any written materials used or to be used in the program.

(16) Any other information that the department requires.