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Welcome Form

Thank you for choosing AccuLab! Your trust means everything to us & we are committed to meeting and exceeding your expectations.

Have questions or need assistance? Call us anytime at

800-688-3904. We’re excited to partner with you & craft the perfect lenses for your patients. Let's get started!

AccuLab Welcome Form

Follow the steps below to complete our Welcome Form.

We will contact you as soon as possible.

* = Required field.

Company name

Company Owner Name(s)

DBA Name

Company Email

Company Street Address

Company Street Address Line 2

City

Region/State/Province

Postal / Zip code

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Company Phone

Primary Contact Phone

Primary Contact Name

Primary Contact Email

How Did You Find Out About Us?

Sales Representative If Applicable

Majority Order/Job Type *

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Preferred Payment Method *

Credit Card

ACH

How Would you Prefer to be Contacted? *

Phone

Email

What Software are you Currently Using to Order Online? *

Not Ordering Online

VisionWeb

DVI/RxWizard

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WIP Report

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