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New U.S. Account Information Form

Full Company Name *

New Account?

Yes

Enter Prospect account number

Bill To:

Bill To First Name *

Bill To Last Name *

Bill To Street Address *

Bill To Address Line 2

Bill To City *

Bill To State *

Bill To Zip Code *

Bill To County *

Bill To Phone Number *

Bill To Fax # *

Bill To Cell#

Bill To Email Address *

Ship To:

Check here if Shipping is the same as Billing

Ship To First Name

Ship To Last Name

Ship To Street Address

Ship To Address Line 2

Ship To City

Ship To State

Ship To Zip Code

Ship To County

Ship To Phone Number

Ship To Fax #

Ship To Cell#

Ship To Email Address

Delivery

Method

Use our Carrier Account#

If blank we'll ship cheapest way

Order information

Please tell us the quantity of products on your order:

Optical

Sunglasses

Readers

Cases

Optical Trade Reference 1

Reference Name:

Phone#

Account#

Optical Trade Reference 2

Reference Name:

Phone#

Account#

Optical Trade Reference 3

Reference Name:

Phone#

Account#

Comments/Questions

How did you hear about us? *

20/20 Magazine	VCPN Magazine	Frames Data
Social Media	Trade Show	Sales rep
Web	Email	Other Other

If you answered Sales Rep, tell us who your sales rep is?

Questions/Comments

Terms and Conditions

I agree to all of McGee Group's Terms and Conditions. * 🛈

I Agree

Completed By: *

Date * +

Signature

clear

New U.S. Account Information Form

Bill To:

Ship To:

Company Information

Order information

Optical Trade Reference 1

Optical Trade Reference 2

Optical Trade Reference 3

Comments/Questions

Terms and Conditions