(2) An application for a restricted permit shall—
(a) be in writing signed by the applicant;
(b) specify—
(i) the full name and address of the applicant;
(ii) each distinguishing name of the unregistered pesticide that the applicant proposes to use;
(iii) the full name and address of the supplier from whom the applicant proposes to obtain the pesticide;
(iv) the purpose for which the pesticide is required; and
(v) the quantity of the pesticide required; and
(c) be accompanied by the determined fee.