Notices of termination required by these regulations shall include, as a minimum, the following: The name and account number of the customer whose service is to be terminated; The address of the premises where service is to be terminated; A statement of the reasons for the proposed termination; The date on or after which the proposed termination will occur; The charges for reconnection of service, if any; A statement of the total amount due, if applicable; A statement of the customer's rights and remedies, which shall include a summary of the dispute procedures, the office address of the utility, and the telephone numbers at which the utility representatives who handle customer complaints may be reached; A statement that it is the responsibility of the customer to notify the utility if he is unable to pay for service in accordance with the requirements of the utility's billing practices; and A statement that it is the responsibility of the customer to notify the utility that he, or an occupant of the premises, is elderly, handicapped, has a serious illness, or relies upon life-support equipment; a brief explanation of the special provisions regarding elderly, handicapped, or persons seriously ill or relying on life-support equipment; and an explanation of notification procedures.