A. The name and address of the applicant;

B. A brief description of the nature of the business and the goods to be sold, or for which orders are to be solicited, and, in the case of products of farm or orchard, whether produced or grown by the applicant;

C. If employed, the name and address of the employer;

D. The names and addresses of at least two reliable residents of the state who will certify the applicant’s good character and business responsibility, or, in lieu of the names of references, any other available evidence as to the good character and business responsibility of the applicant as will enable an investigator to properly evaluate such character and business responsibility;

E. A statement as to whether or not the applicant had been convicted of any crime, misdemeanor or violation of any municipal ordinance, including the nature of the offense and the punishment or penalty as assessed therefor.