SALES INFORMATION REQUEST

Contact Information Current Business Equipment Interests

First Name

Last Name

Company Name

Street Address

City

State/Province/Region

Zip

Phone Number

Country

Email Address

Business type:

Wholesale Retail Other

You chose "retail," please specify no. of stores:

You chose "other," please specify:

What materials do you intend to process? Specify lens index.

What is your Rx jobs capacity per day?

Do you or your staff have Rx lens processing experience?

Yes No

What is the purpose for your information request?

New Lab Setup Upgrade Other

You chose "upgrade," please specify which equipment you would like to upgrade.

What is your system preference? (Automated systems have a higher output & superior accuracy and finish)

Automated Manual

What type of process do you prefer?

Conventional Free-form

What other equipment are you interested in?

	Hard Coater (Spin)	Hard Coater (Dip)	Anti Relection Coater	Edging	Tinting	Reconditioned Equipment
Yes
No

Other?

What is your budget?

What is your purchasing time-frame?