The license, when issued, shall be in a form prescribed by the licensing authority and shall include:
(1) The name of the licensee;
(2) The nature and type of service to be performed;
(3) The business name under which the licensee is authorized to operate;
(4) The addresses of the locations where the licensee is authorized to operate; and
(5) The number and date of the license and its date of expiration.