*indicates required field
*Type of Account (select one):
A value is required.
*Office Name 1
Office Name 2
*City, State, Zip
(if different from above)
If you have not already received Pech price book(s) which would you like to have included with your welcome packet?
*Preferred method of shipping
UPS 2nd Day
Crystal Courier (CO only)
ASAP (NE Only)
Method of billing
If buying group, your preferred group:
If you are affiliated with other Pech offices/accounts please list their name(s):
Sales Representative (if known)
Additional Information needed :
Do you prefer any of the following automatic services (check all that apply)
Automatic Cote on CR-39
Polish Edges on Rimless
Optimization on Wrap Frames
Please enter the following word - "orange"
Errors: There are some errors in the form. You may have to scroll up to correct them.
© 2017 Pech Optical Corp | 800.831.2352 |
| site designed by