Section 5. Application for licensure.
An application for a license under this act shall be submitted to the department in the form required by the department and shall include the following:
(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.
(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.