(a) The name and registration number of the service dealer and the address and telephone number of the location where the set or appliance will be repaired.

(b) The date the set or appliance was accepted or received by the service dealer.

(c) A description of the set or appliance including model and serial number.

(d) A summary of the customer's description of the problem associated with the set or appliance.

(e) The name and address of the customer.

(f) The complete and legible signature or employee number of the person accepting or removing a set or appliance.

(g) There shall be printed on the receipt in prominent type the following statement:

“An estimate as required (Section 9844 of the California Business and Professions Code) for repairs shall be given to the customer by the service dealer in writing, and the service dealer may not charge for work done or parts supplied in excess of the estimate without prior consent of the customer. Where provided in writing, the service dealer may charge a reasonable fee for services provided in determining the nature of the malfunction in preparation of a written estimate for repair. For information contact the Bureau of Household Goods and Services, Department of Consumer Affairs, Sacramento 95834.”

(h) Removal and reinstallation charge, if any.

(i) When the personal property accepted or received by the service dealer is intended for personal, family, household or home office use, the service dealer's receipt shall include a statement, if such is the case, that such deposited property is not insured or protected to the amount of the actual cash value thereof against loss occasioned by theft, fire, and vandalism while such property remains with the service dealer or his representative, pursuant to the provisions of Section 1858.1 of the Civil Code.