Follow the steps to complete the purchase agreement online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the business or clinic name at the top of the agreement. This identifies the seller providing the hearing instrument.
3. Fill in the address fields, including ADDRESS 1 and ADDRESS 2, along with the appropriate phone and fax numbers. Accurate contact details ensure effective communication.
4. Enter the client’s name, date of birth, and address. These details confirm the identity and location of the person purchasing the hearing instrument.
5. Input the home phone and any other phone numbers where the client can be reached. This facilitates follow-up communication.
6. Detail the hearing instrument information. Specify the ear (left or right), condition (new, used, or reconditioned), manufacturer, model/style, and battery size for the product.
7. Input all relevant financial information, including the amounts for each instrument and options selected. Calculate the subtotal amount, Minnesota care tax, and total purchase price.
8. List any additional options, warranties, protection plans, and discounts if applicable, ensuring clarity on all costs involved.
9. Ensure the client initials the space confirming they have read and reviewed the Minnesota Department of Health brochure regarding consumer rights.
10. Fill in the deposit amount and balance due on delivery. This section confirms the financial agreement between the client and the provider.
11. Review the cancellation rights provided in the document, ensuring the client understands their rights under Minnesota state law.
12. Complete the agreement by securing the client and audiologist/hearing instrument dispenser signatures along with their respective dates.
13. After completing all necessary fields, save the changes to the form. You may also choose to download, print, or share the completed document as needed.

Complete your MN Hearing Instrument Purchase Agreement online today to ensure a smooth and informed purchasing experience.