Open new account

Open New Account

"*" indicates required fields

To become a Luzerne Optical customer, please complete the following information. You will be notified when your account has been set up---in approximately 5 business days.

Ship to:

Owner's First Name
Owner's Last Name
Address 1
Address 2
City
Country
State / Province
Zip / Postal Code
Contact Name*
How did you hear about luzerne optical?
Courier services you are currently using?

Bill to:

Address 1
Address 2
City
Country
State / Province
Zip / Postal Code

Credit application:

Type of work to be ordered from luzerne optical?
Attention mail room, please send me: