B. The contract shall be accompanied by a completed form in duplicate, entitled "notice of cancellation", which shall be attached to the contract and easily detachable and which shall contain in at least ten point type the following statement written in the same language as used in the contract: Notice of Cancellation You may cancel this contract without any penalty or obligation within three days from the date the contract is signed. If you cancel, any payment made by you under this contract will be returned within fifteen days after receipt by the credit services organization of your cancellation notice. To cancel this contract, mail or deliver a signed and dated copy of this cancellation notice, or any other written notice, to (name of credit services organization)
_______________________________________________ at
(address of credit services organization) (place of business)
__________________________________________________________ _________________
not later than midnight (date) ________________.
I hereby cancel this transaction. (date) ________________
(purchaser's signature)
_________________________________