Cherry Optical Lab | New Accounts

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New Accounts

On behalf of the entire Cherry team here in Green Bay, Wisconsin, I'd like to personally take this opportunity to thank you for choosing us as your laboratory. We are excited to have you as part of our family. Should you have any questions, please reach out to me directly at (920) 469-2559.

- Adam Cherry, President of Cherry Optical Lab

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Sales Representative Where Applicable (Required)

Not ApplicableBill LeeCharmaine BrennerDeb UllrichEthan DolbyJason LinkJennifer Felix GrayJennifer WilsonJenny WebbJess HartigJoann CaposselaJoanna RuizKathryn SanetraKellie KennewegLisa TinsonMichelle PepinMike StokerPaige KraemerRyan GogaSara JordisonValerie Kero

Business Name (Required)

DBA Name if Applicable

Business Owner Name(s) (Required)

How did you find out about us? (Required)

Business Street (Required)

City (Required)

State (Required)

Zip Code (Required)

Business Phone (Required)

Business Fax (Required)

Primary Email (Required)

Business Website

Facebook Page

Business Hours

Is your billing address and billing contact person the same as your primary business information?

YesNo

Billing Contact

Billing Street

City

State

Zip Code

Billing Phone

Billing Fax

Is your primary optical contact the same as the primary business contact?

YesNo

Primary Optical Contact(s)

Optical Contact Email(s)

Optical Contact Phone

Optical Contact Fax

Are you a provider for any of the following? If yes, select all that apply.

NeuronlensNeuroVisual Medicine InstituteShaw VisionSwissflex

All customers receive paper statements. Would you also like to receive e-statements? (Required)

YesNo

Preferred Payment Method (Required)

Credit CardACH

Would like to be contacted by our accounting dept. to setup auto-pay or review any other billing questions? (Required)

Yes - please contact the Business OwnerYes - please contact the Primary Billing ContactYes - please contact the Primary Optical ContactNo, thank you.

Are You Currently Ordering Electronically? (Required)

YesNo

What software are you currently using to order online? (Required)

Not Ordering OnlineVision WebDVI/RX Wizard

Order/Job Type (Required)

EdgedUncutBoth

Once your account is set up do you require any of the following?

Shipping LabelsFrame TagsPaper Order Forms

Other Notes or Questions?

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