(1) A registrant shall provide to each person to whom he or she sells or leases a hearing instrument a bill of sale that shall at a minimum contain the following information:

1. (a) the registrant’s hearing instrument specialist license number;
2. (b) the name of the registrant or the registrant’s current business name as listed with the Secretary of the Commonwealth;
3. (c) the current business telephone number and address of the registrant;
4. (d) the brand, model, manufacturer or manufacturer’s identification code, and serial number of the hearing instrument furnished at point of delivery;
5. (e) an itemization of the total purchase price including, but not limited to the cost of the hearing instrument, ear mold, batteries and other accessories, and any services provided,
6. (f) a statement notifying the purchaser of the limited money back guarantees as set forth in 265 CMR 6.04 and a clear and precise statement of any guarantee or trial period;
7. (g) the name, address and signature of the purchaser;
8. (h) the date of consummation of the sale;
9. (i) a statement whether the hearing aid is new, used or reconditioned; and
10. (j) the waiver required by the provisions of M.G.L. c. 93, § 74.