Return to Information Page New Account Form To become a Luzerne Optical customer, please complete the following information. You will be notified when your account has been set up, approximately 5 business days.
Return to Information Page
New Account Form
To become a Luzerne Optical customer, please complete the following information. You will be notified when your account has been set up, approximately 5 business days.
Ship To Account Name Please Select One MD OD Optician Retail Lab, Wholesale Group Low Vision Clinic Other If other please specify Owner's Name Street Address City State Zip Phone (including area code) Fax (including area code) Contact Name Email Address Courier Services currently using (check all that apply) Airborne Express Fed Ex UPS Comet MGG-Harper's Pittsburgh MGG US Mail Route Bill To Name Buying Group None ADO AECC Blew Eyes Block C&E ECA HMI Midwest OPN UVCBS Vision West Buying Group Account Number (if applicable) Address City State Zip Additional Information Type of work to be ordered from Luzerne Optical (check all that apply). Uncut/Stock Lenses Edged & Mounted Work Frames/Sunglasses Low Vision Products RGP Contacts Soft Contacts AR Coating Safety Glasses Optical Tools & Accessories Are you interested in viewing our online specials? Are you interested in ordering online? Other Comments
Ship To
Additional Information
Type of work to be ordered from Luzerne Optical (check all that apply).
Are you interested in viewing our online specials? Are you interested in ordering online?
Other Comments
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