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Disclosure Statement. Notice to Customers.This contractor is registered with the state of Washington, registration no. . . . The Model Disclosure Statement is a type of preliminary notice. To use this document properly, the provider or facility should review and complete it in a manner consistent with applicable state and federal law. HHS. Model forms for risk-based pricing and credit score disclosure exception notices (Appendix H to Part 1022). A Contractor's Disclosure Statement Notice to Customer. ("Notice") is attached as Exhibit D. Under Washington law, Owner's signature is required on the. Regulation CC also requires notice to the depositary bank and to a customer of nonpayment of a check. Selling Homeowners MUST complete: Residential Property Disclosures Acknowledgement Form.