Become a Vision West Vendor

Market to our 3,500+ nationwide members by becoming a Vision West Vendor!

Our membership base consists of ophthalmologists, optometrists, and opticians that work within an independent practice environment. When you become a Vision West Vendor, you have the freedom of marketing to our large membership database of ophthalmologists, optometrists, and opticians. To help with your marketing efforts we provide several unique advertising options that assist in promoting your services to our members.

Visit the Marketing Programs link located on the left navigational bar to read more about the exciting advertising options available through Vision West. Increase your sales and enhance your business potential-become a Vision West Vendor today!

If you would like to be considered as a vendor for Vision West, please fill out the submission form below and submit for consideration.

Your Information

* Contact Name:

* Title:

* Contact E-Mail:

* Contact Phone:

Contact Phone (ext):

Company Information

* Company Name:

* Address:

* City:

* State: Please Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

* Zip:

* Toll Free Phone:

Toll Free Fax:

Website:

* Year Company Established:

Contact Information

President/Owner: Ext:

E-Mail:

Sales Manager: Ext:

E-Mail:

Marketing Contact: Ext:

E-Mail:

Billing Contact: Ext:

E-Mail:

Southern CA
Sales Rep:

Cell Phone:

eMail:

Northern CA

Sales Rep:

Cell Phone:

eMail:

New Account / Conversion

Contact:

Ext:

E-Mail:

Nightly Status Report

Contact:

Ext:

E-Mail:

Product Information

Are You A:
Please Select Manufacturer Distributor Other

If Other please specify:

What type of products or services do you sell?

Frames

Price Range:

Please Select - Make multiple selections by pressing Ctrl (Command on Mac) on keyboard while clicking on each menu item.

Exclusive High Mid Low

Discount:

Product Category:

Please Select - Make multiple selections by pressing Ctrl (Cmd on Mac) on keyboard while clicking on each menu item.

Men's Women's Children's Clip Ons Luxury Overstock Sport Sunglasses Botique Designer Speciality

Soft Contact Lenses

Discount:

Brands:

Please Select - Make multiple selections by pressing Ctrl (Cmd on Mac) on keyboard while clicking on each menu item.

Ciba Vistakon Cooper Vision Baush & Lomb Other

GP Lenses

Discount:

Brands:

Please Select - Make multiple selections by pressing Ctrl (Cmd on Mac) on keyboard while clicking on each menu item.

Boston
Paragon
Other

Laboratory Services

Discount:

Are you VSP approved?: Please Select No Yes

Equipment

Discount:

Supplies

Discount:

Case / Accessories

Discount:

Business Services

Discount:

Other:

Buying Group Discount :

 

Direct Discount :

What is your Return and Exchange Policy

Billing Information

Vision West only excepts electronic billing. If you are approved, samples files will be sent to you so that you can begin testing the billing.

Vision West requires a *.csv or *.txt file to complete billing.

Additional Information

1) If approved you will have a 90 day probationary period
2) Minimum Monthly Volume Required of $5,000
3) Vision West adds a maximum of 5 new vendors every quarter
4) Vendors with no sales force will not be approved
5) All customers must be verified to be billed through Vision West