In the event time-price differential charges are made pursuant to this part, the purchaser of insurance must agree to the charges in writing, and the instrument must contain:

(1) The cash price of the insurance policy or bond and the amount of the initial payment, if any;
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(2) The difference between the two (2), if any;
(3) The principal balance owed;
(4) The amount of the time-price differential; and
(5) The time balance owed by the buyer.
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