25 CFR §141.34

1. (a)Transaction number.
2. (b)Name of pledgor.
3. (c)Address of pledgor.
4. (d)Census number or social security number of pledgor.
5. (e)Date of transaction.
6. (f)Replacement value of pawn.
7. (g)Description of pawned item.
8. (h)Amount loaned in cash.
9. (i)Amount loaned as credit.
10. (j)Finance charge.
11. (k)Amount financed.
12. (l)Date and amount of payments made by pledgor.
13. (m)Date notice of default sent to pledgor.
14. (n)Date pawned item sold.
15. (o)Name and address of purchaser.
16. (p)Amount received upon sale.
17. (q)Amount of any surplus returned to the pledgor.
18. (r)Such other information as the Commissioner may require.