Application for a commercial pesticide applicator license provided for in RCW 17.21.070 shall be on a form prescribed by the director.

(1) The application shall include the following information:

(a) The full name of the individual applying for such license.

(b) The full name of the business the individual represents with the license.

(c) If the applicant is an individual, receiver, trustee, firm, partnership, association, corporation, or any other organized group of persons whether incorporated or not, the full name of each member of the firm or partnership, or the names of the officers of the association, corporation or group.

(d) The principal business address of the applicant in the state or elsewhere.

(e) The name of a person whose domicile is in the state, and who is authorized to receive and accept services of summons and legal notice of all kinds for the applicant.

(f) The model, make, horsepower, and size of any apparatus used by the applicant to apply pesticides.

(g) License classification or classifications for which the applicant is applying.

(h) A list of the names of individuals allowed to apply pesticides under the authority of the commercial applicator's license.

(i) Any other necessary information prescribed by the director.

(2) Any changes to the information provided on the prescribed commercial applicator form shall be reported by the business to the department within thirty days of the change.