Kasperek Optical Account Application

Please complete form below. An Kasperek Optical representative will contact you when application has been processed.

 
Business Type:
Set as Primary Bill To?
Set as Primary Ship To?
AR, CA, IL, MO, NV, TN only - Exempt from sales tax?
If yes, please mail or fax Sales Tax Exemption Certificate

Bill through Buying Group or Co/Op?