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.