(1) The residential roofing services provider's:
(A) Business mailing address for cancellation purposes;
(B) Telephone number;
(C) License or registration number of any contractor, home improvement contractor, or public adjuster license or registration held in this or any other state; and
(D) Electronic mail address or facsimile number for cancellation purposes, if available;
(2) A detailed description of all damage or repairs to be claimed or covered by the contract and the location of such damage;
(3) A written statement in boldface type of a minimum size of ten (10) points, containing language substantially similar to the following:
(4) A form in duplicate, captioned “NOTICE OF CANCELLATION”, attached in an easily detachable manner to the contract, that contains in boldface type of a minimum size of ten (10) points the following statement or language substantially similar: