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To become a Luzerne Optical customer, please complete the following information. You will be notified when your account has been set up---in approximately 5 business days.

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Account Name

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If Other, Please Specify

Owner's First Name

Owner's Last Name

Address 1

Address 2

City

Country

State / Province

Zip / Postal Code

Fax (Include Area Code)

Contact Name

eMail Address

How did you hear about Luzerne Optical?

Trade Show

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Courier Services you are currently using?

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Bill To:

Last Name

First Name

Buying Group

Buying Group Account Number (if applicable)

Address 1

Address 2

City

Country

State / Province

Zip / Postal Code

Phone (Include Area Code)

Credit Application:

Type of Work to be Ordered from Luzerne Optical?

Edged & Mounted Work

Uncut/Stock Lenses

Frames & Sunglasses

Low Vision Products

GP - Gas Permeable Contacts

Soft Contacts

AR Coating

Safety Glasses

Binoculars, Telescopes, Riflescopes

Optical Tools & Accessories

Pharmaceuticals & Diagnostics

Attention Mail Room, Please Send Me:

Spectacle Rx Order Forms

Fax Spectacle Rx Order Forms

Fax GP Contact Lens Order Forms

GP Contact Lens Order Forms

Fax Soft Contact Lens Order Forms

Fax Stock Lens Order Forms

Courier Return Labels

FedEx Return Labels

UPS A.R.S. Return Labels

U.S. Post Office Postage Paid Mailing Labels

Frame to Follow Tags

U.S. Post Office Postage Paid Envelopes

Zeiss AR Coating Envelopes

Additional Information:

Are you interested in viewing our online specials?

Are you interested in ordering online?

Other Comments

Enter catalog

New products New products

TheraBlue Lenses

CrownView Lenses

TheraBlue Sun

Shamir Autograph InTouch Lenses

Definity 3 & 3 Plus Lenses

VARILUX S Series Lenses

Polar365™ Polarized Lenses!

2015 New Product Announcements

Current pomotions Current pomotions

Eyewear by ROI
New Releases!
( ALEXANDER JULIAN: COLOURS, RICHARD TAYLOR: SCOTTSDALE, & BULOVA )

See promotional flyer(s) for details:.
Current Optical Promotions