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Carl Zeiss Vision Rewards Program Enrollment Form
 
As a participant in the Rewards Program, I agree to the following:
  • Commit to dispense Carl Zeiss Vision progressives as my product of choice.
  • Understand that I must dispense a minimum of 10 (ten) pair of any combination of qualifying lenses per month to accrue dividends.
  • Agree to have all employees involved in dispensing and processing Zeiss products complete the Carl Zeiss Vision Strength Training Seminar.
  • Agree to schedule training for dispensing and processing employees hired after our initial certification.
Authorized Practice Representative
First Name *
Last Name *
Title *
Phone *
Email *
Date *
 
Practice Information
Practice *
Address *
City/ST/ZIP *
Phone *
Fax
Website
 
 
Questions/Inquiries
 
Do you have branch locations? *
Yes No
If the answer is yes - please fax branch details to 804-530-8322
Are you a Teflon Certified Practice? *
Yes No
 
Are you a Vision Source member? *
Yes No
 
*   Indicates a required field.