Vision West - VWI - Ophthalmic Buying Group Serving Eye Care Industry



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This VWI Membership Application is made and submitted by the applicant named below for the purpose of joining a membership organization administered by VWI to participate in purchasing tools for ophthalmic products and services. In the event that VWI approves the Application, Applicant’s membership in the organization, as well as any purchases made pursuant thereto, shall be governed by the terms and conditions set forth in the VWI Membership Agreement, which is stated below.

APPLICANT's INFORMATION

Applicant Name :

Type :

Primary Practice Name :

Office Mgr Name :

Business Address :

City :

State :

Zip :

Phone :

Fax :

Email :

Home Address :

Home City :

State :

Zip :

Home Phone :

Secondary Practice Name :

Office Mgr Name :

Business Address :

City :

State :

Zip :

Phone :

Fax :

Email :

If you have more than one practice location, please indicate:

Combine purchases on 1 statement, send to primary office
Create individual accounts for each location

BUSINESS INFORMATION

Business Type :

Corporation Name :

Principal's Name :

Drivers Lic # :

Soc Sec # :

(Enter as xxx-xx-xxxx)

Fed Tax ID # :

(Enter as xx-xxxx)

State Lic # :

# Yrs in Business :

# Yrs at Current Location :

Bank Name :

Bank Acct # :

Branch Address :

City :

State :

Zip :

Contact Name :

Phone :

Credit Card :

Credit Card Acct # :

Exp Date :

Trade Reference Name :

Phone :

Acct # :

State/Group Affiliation :

NEW MEMBER SURVEY

Thank you for applying for membership with VWI. We are pleased to include you as one of our valued members. In order to improve our services and better meet your needs, we ask that you complete the questions below.

1. How did you hear about VWI?

State Association/Group AffiliateLocal Society
Trade ShowEducation Event
Colleague RecommendationVWI Member Benefits Consultant
VWI BrochureVWI Website
VWI OptiCenterVWEYE Today
Other
Name of Person Who Referred You :

2. Why did you decide to join VWI? (mark all that apply)

Vendor Selection/Discounts

Straight-forward Billing Structure

Education Events

VWI's Vendor Promotions

Helpful Customer Service

Online Payment Convenience

Support of Group or State Affiliation

Member Resources (Newsletter, Business Services, etc.)

3. What is your billing preference?

Email/OnlinePaperFax

4. What other buying groups & affiliations do you belong to?

AllianceBlockOOGPC&EPENOther

5. What services can VWI provide for your practice?

MEMBERSHIP AGREEMENT

Member does not agree with the terms of this Agreement, Member must immediately notify VWI and refrain from purchasing any Products or making any use of the Program. 

AUTHORIZATION TO PURCHASE PRODUCTS

Account Number and Credit Line. In the event that Member’s Application is approved by VWI, VWI will issue Member an account number and extend to Member a credit line. The amount of the credit line shall be determined by VWI in its sole discretion and may be changed upon ten (10) days prior notice or immediately upon notice if Member fails to pay any amount when due. Member shall not make purchases in excess of the available credit line at any time. Member hereby represents and warrants to VWI that (a) the credit line established pursuant to this Agreement, (b) all purchases made by Member under this Agreement, and (c) any and all debt incurred by Member in the course of the activities contemplated by this Agreement, are established, made and incurred for business, commercial and professional purposes of Member, and not for any personal, family or household purpose of Member or any of Member’s owners, officers or employees, as applicable.
Member Purchases. VWI shall provide Member with a list of approved Vendors from whom Member may purchase products through the Program. When Member decides to purchase from a VWI Vendor, Member gives VWI the ability to contact the Vendor to open or convert the account on the Member’s behalf . Nothing in this agreement is intended to, nor shall be construed to, prevent Member from purchasing products and services outside the program.
Inspection of Purchases. VWI does not endorse or recommend any Vendor or any Product. Vendors are independently owned and operated businesses. All orders are subject to acceptance by the Vendor. Member is solely responsible for selecting the Vendors with whom he or she wishes to deal and the Products that he or she wishes to purchase. Upon receipt of any shipment of Products, Member shall promptly inspect such shipment as to quantity and quality and shall immediately inform the particular Vendor of any discrepancies. Member’s failure to comply with the acceptance and return procedures of a Vendor may prohibit Member from returning a Product or otherwise receiving a credit.
Liability for Purchases. Member shall be fully respon¬sible for all purchases made with the Account Number, regardless of who actually placed the order for Products. To protect against unauthorized use of the Account Number, Member agrees to maintain appropriate security precautions to prevent unauthorized access to or use of the Account Number. In the event that Member suspects or is aware that the security of the Account Number has been compromised, Member shall immediately notify VWI of such circumstances.

PAYMENT FOR PURCHASES

Payment to Vendor. Subject to the terms of this Agreement, VWI shall pay Vendor for purchases made by Member with the Account Number through the Program and in accordance with the terms of this Agreement. Such payments shall be made pursuant to the terms of a separate written agreement between VWI and each approved Vendor. VWI’s obligation to pay Vendors for Member’s purchases shall immediately terminate upon any termination of this Agreement.
Payment to VWI. On a monthly basis, each Vendor will provide VWI with a statement listing the purchases made by Member [and the discounts received] during the preceding calendar month. Member shall pay VWI for all Product purchases made by Member from Vendors as shown on each Vendor’s statement. Each calendar month VWI will deliver to Member a statement for Product purchases made by Member during the preceding calendar month. Member shall have five (5) days from the date of the statement to notify VWI of any discrepancies in the Products purchased or amounts due for that particular billing period. If Member fails to notify VWI of any discrepancy within the five (5) day period, Member shall be deemed to agree with and have accepted the purchases and amounts reflected in such statement. Member shall pay the full amount of the statement, including the Administrative Fee, by the due date indicated on the statement. 
Administrative Fee. In consideration for VWI’s services in administering the Program, Member shall pay to VWI an administrative fee equal to a percentage of Member’s Product purchases during the preceding month (the “Administrative Fee”). The Administrative Fee shall be listed on the monthly statement provided by VWI, and Member shall pay the Administrative Fee as part of the total statement amount. VWI reserves the right to change the amount of the Administrative Fee from time to time upon thirty (30) days prior notice to Member. For the current amount of the Administrative Fee, Member should contact its VWI representative.
Late Payments. In the event that Member does not pay any amount when due, the provisions set forth below shall apply:
Member shall not be entitled to any discounts for product purchases and will therefore be assessed a discount reduction fee equal to fifteen percent (15%) of Member’s activity for the applicable billing period. The discount reduction fee will be applied to your next statement.
If any amount is not paid within thirty (30) days from the date of the invoice, then such overdue payment will accrue interest from the original due date at one and one half percent (1.5%) per month or the highest rate allowed by law, which¬ever is lower.
In addition, members whose checks are returned will be assessed a returned check fee consistent with the check return policy of VWI’s financial institution.
Failure to Pay. In the event that Member fails to pay any amount when due, VWI shall have the right to suspend immediately Member’s ability to use the Account Number and to otherwise purchase Products from Vendors without notice and without demand. 
MEMBER EXPRESSLY AGREES AND ACKNOWLEDGES THAT IT WOULD BE EXTREMELY IMPRACTICABLE AND DIFFICULT, IF NOT IMPOSSIBLE, TO DETERMINE THE DAMAGE AND HARM WHICH VWI WOULD SUFFER IN THE EVENT MEMBER FAILS TO PAY AMOUNTS DUE AND OWING UNDER THIS AGREEMENT. ACCORDINGLY, IF MEMBER FAILS TO PAY PROMPTLY ANY OUTSTANDING ACCOUNT WHEN DUE, AND VWI IS REQUIRED TO PURSUE COLLECTION EFFORTS, VWI SHALL BE ENTITLED TO RECOVER FROM MEMBER, AS LIQUIDATED DAMAGES, THE FULL AMOUNT OUTSTANDING, ANY LATE PAYMENT FEES ACCRUING THEREON, AND AN AMOUNT EQUAL TO 35% OF THE OUTSTANDING AMOUNT AS COLLECTION FEES, AS A REASONABLE ESTIMATE OF THE TOTAL NET DETRIMENT THAT VWI WOULD SUFFER IN THE EVENT OF MEMBER’S DEFAULT AND FAILURE TO PAY WHEN DUE HEREUNDER. THIS SUM SHALL ONLY LIMIT VWI’S DAMAGES FROM MEMBER’S FAILURE TO DISCHARGE MEMBER’S PAYMENT OBLIGATION.
SOME STATES DO NOT ALLOW THE IMPOSITION OF LIQUIDATED DAMAGES AS DESCRIBED IN THE PRECEDING PARAGRAPH. IN SUCH STATES, IF MEMBER FAILS TO PAY PROMPTLY ANY OUTSTANDING AMOUNT WHEN DUE, AND VWI IS REQUIRED TO PURSUE COLLECTION EFFORTS, VWI SHALL BE ENTITLED TO RECOVER FROM MEMBER, TO THE FULLEST EXTENT PERMITTED BY APPLICABLE LAW, THE FULL AMOUNT OUTSTANDING, ANY LATE PAYMENT FEES ACCRUING THEREON, AND ALL COSTS AND FEES, INCLUDING COLLECTION COSTS, THAT VWI SUFFERS IN THE EVENT OF MEMBER’S DEFAULT AND FAILURE TO PAY WHEN DUE HEREUNDER.
The foregoing rights shall be in addition to, and not in lieu of, any other rights or remedies available to VWI under this Agreement or at law or in equity.
Payment Information. Member hereby authorizes VWI to collect credit and other financially-related information about Member. VWI may use such information to determine Member’s financial condition, to administer Member’s membership in the Program and to provide payment history and credit information to credit reporting agencies.
Taxes. Member is responsible for all taxes that result from Member’s purchase of any Products, including without limitation all sales, value added and other taxes. If any such amounts are initially paid by VWI to Vendor, Member agrees to pay all such amounts in full pursuant to an invoice therefor.

ACCESS TO VWI WEBSITE

As part of membership in the Program, Member may receive a user name and a password to enable Member to access password-protected areas of VWI’s web site located at www.vweye.com (the “Website”). Member shall make reasonable efforts to maintain the security of user names and passwords and shall promptly notify VWI if a password is lost, stolen, disclosed to an unauthorized person or may otherwise have been compromised.

MEMBER SUPPORT

VWI shall provide customer service support to assist Member in utilizing the benefits, which consist of telephone, fax and email support. VWI will provide the customer service Monday through Friday between the hours of 7:00 a.m. and 5:00 p.m. Pacific Standard Time, excluding holidays observed by VWI.

PROGRAM CHANGES

Modifications by VWI. In an effort to improve the quality and breadth of the Program, VWI may make changes, corrections and other modifications to the Program from time to time. Unless otherwise expressly indicated, all such changes are effective upon notice to Member, except for changes in fees and charges which become effective thirty (30) days from the date of notice.
Third Party Participation. Member is aware that the Program requires the participation of many third parties, including vendors, suppliers, affiliated organizations and even other members. Accordingly, the Program may include benefits and features that depend entirely or partly on the actions of such third parties. Therefore, Member’s ability to purchase from a particular Vendor, to purchase a particular Product or obtain a particular benefit may change from time to time depending on these third party actions.

CONFIDENTIALITY

Member acknowledges and agrees that the Vendor list, pricing information and other information made avail¬able by VWI to Member is confidential information of VWI (“Confidential Information”). Member agrees not to use the Confidential Information for any purpose other than to purchase Products through the Program. Member shall not disclose the Confidential Information to any third party, except to Member’s employees, accoun¬tants and other consultants. Upon any termination of this Agreement, Member shall immediately destroy all Confidential Information unless that VWI requests that it be returned.

INTELLECTUAL PROPERTY

Member acknowledges and agrees that Member is not receiving any interest in the Program or any of VWI’s intellectual property rights other than the right to purchase Products from Vendors through the Program subject to the terms and conditions of this Agreement. VWI shall own all right, title and interest in and to the Program, the Confidential Information, the Website and all intellectual property rights therein, including without limitation pat¬ents, copyrights, trade secrets and trademarks. Member acknowledges and agrees that no license or rights of any kind to any third party or VWI software, trade secrets, trademark, trade name, logo, product designation or other intellectual property rights are granted to Member in this Agreement and all such rights are reserved by VWI and its licensors.

ELECTRONIC MEMBER AGREEMENT

This application is subject to acceptance or rejection by VWI in its sole discretion. Applicant hereby authorizes VWI to obtain personal and/or business credit reports in connection with evaluating this Application and administering participation in the program. By completing the information below I (the undersigned) hereby agree to all the above terms and conditions of the VWI membership agreement, and unconditionally personally guarantee performance of above terms and conditions by the primary practice named and any and all other accounts not specifically named in this agreement of which I have an ownership in, and payment of sums due there under in the event of default, and hereby waives any right to claim release or exoneration by reason of any modification, amendment, or extension or notice thereof. This guarantee shall be a continuing and irrevocable guarantee and indemnity to VWI.

Principal Owner Initials :		2nd Principal Owner Initials :
Principal Name :		2nd Principal Name :
By checking this box, I have read, understand and agree to the terms and conditions above.		By checking this box, I have read, understand and agree to the terms and conditions above.

This Application is Dated : 7/23/2008

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