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Resident Agent (Required for Out-of-State Businesses)
This section applies to corporations, limited liability companies, and limited partnerships only. A resident agent
or registered office must be listed if your business is not based in Pennsylvania. This is the person/office
authorized by your business to accept service of legal papers.
http://www.dos.pa.gov/BusinessCharities/Business/Resources/Pages/Commercial-Registered-Office-Providers.aspx
Out-of-state businesses must also provide the registration or license number issued by the home state.
Business Background Information
Each business applicant must check all circles to the background information concerning the business.
Section C – Personal Information
Each individual, owner, officer, manager, partner, or party to a joint venture must provide data and check all
circles under the personal background information.
Social Security Numbers and driver’s license information must be provided but will not be publicly disclosed.
Fax numbers and email addresses are optional; however, we can contact you more quickly if necessary if this
information is provided.
If the person does not have a driver’s license, the person must provide the number and issuing state of a state-
issued identification card. Those without a driver’s license are required to submit a copy of their ID card with
their application.
If any person or business listed in the application operated a home improvement business in the past, the
name(s) and address(es) of the business(es) must be listed in the application. Check all circles under prior
business background information.
Section D – Shareholder/Equity Owner Information
Corporations, limited liability companies and limited partnerships must provide the names of all directors or
parties holding a 5% or greater equity interest.
Section E – Other Registrations or Licenses
If the business is currently registered or licensed as a contractor in any other political subdivision, agency,
municipality, state, or country, including a local or municipal registration or license, please complete this
section, for each such license or registration. NOTE: HICPA requires you to report any disciplinary action
related to such registration(s) or license(s) listed in this Section, to the Bureau of Consumer Protection, in
writing, at the address noted above, within 90 days of final disposition.
Section F – Description of Business
Describe all goods and services offered or provided in Pennsylvania by your business.
Section G – Insurance
Insurance Policy Coverage – the name of the insured must be in the business name.
Provide information regarding the businesses’ insurance coverage for bodily harm (personal injury) and
property damage. If the required coverage is provided under more than one policy or by more than one
insurer, please list each policy separately, attaching additional pages as necessary.