(1) The date of the transaction;
(2) The name of the person conducting the transaction;
(3) The name, age, and address of the customer; a description of the general appearance of the customer; and the distinctive number from the customer's driver's license or other similar identification card;
(4) An identification and description of the pledged or purchased goods, including, if reasonably available, the serial, model, or other number, and all identifying marks inscribed thereon;
(5) The number of the receipt or pawn ticket;
(6) The price paid or the amount loaned;
(7) If payment is made by check, the number of the check issued for the purchase price or loan;
(8) The maturity date of the transaction; and
(9) The signature of the customer.
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