(1) Licensees shall use a form that is substantially similar to the Mortgage Loan Origination Disclosure form dated September 23, 2011, which is available on the department's website at banking.mt.gov. Licensees may customize the form to meet their individual needs.

(2) The disclosure must include the address, phone number, facsimile number, e-mail address, and website of the department.

(3) The disclosure must include the unique identifier issued by the NMLS for the employing entity and mortgage loan originator.

(4) The disclosure must be signed by the borrower and co-borrower, if any, and the mortgage loan originator.