Every bail bondsman shall, at the time of obtaining the release of an arrestee on bail, deliver, and keep a copy for his or her own records, to such arrestee or to the principal a numbered document signed by the arrestee containing the following information as prescribed in Appendix C:

1. (1) The name of the bail bondsman;
2. (2) The name, address, and telephone number of the professional bail bond company;
3. (3) The name of the arrestee;
4. (4) The date of arrest;
5. (5) The date of release of the arrestee;
6. (6) The date, time, and place of the arrestee's required appearance, if known;
7. (7) The amount of bail;
8. (8) The offenses with which the arrestee is charged;
9. (9) The premium for the bail bond;
10. (10) The amount received; and
11. (11) A description of and receipt number for any collateral received.