A motor fuel retailer may, within thirty days of the occurrence, demand payment from the motor vehicle owner for the motor fuel received by sending a notice by certified mail, return receipt requested. The notice shall be prescribed by the Department of Public Safety and include the following information:

1. (1) The name, address, and license plate number of the motor vehicle owner;
2. (2) Date the act occurred;
3. (3) Type of motor fuel;
4. (4) The unpaid dollar amount;
5. (5) The service charge;
6. (6) A citation of §§ 22-30A-40 and 22-30A-43; and
7. (7) The employee's and employer's signature.

Source: SL 2005, ch 121 , § 3.