Become a K-Mars Customer Open a K-Mars Optical Account New Account Information and Credit Review "*" indicates required fields Applicant’s Name* First Payment Method* Company Check Credit Card Company Name* Billing Address* Street Address City State / Province / Region ZIP / Postal Code Email* Phone*Business Type* Sole Proprietor Partnership Corporation LLC Owner’s /Partner’s Name(s)* Business License #* Soc. Sec or FEIN#* State Sales Tax ID#* Number of Years in Business*Accounts Payable Contact:* Ship To Address if different than the billingPlease list addresses. Please advise if individual account number or individual drop ship desiredBusiness NameAddressCityZipcode Add RemoveBank DetailsBank Name* Contact Name* Account No* Please provide 3 Trade References (One of the references must be an Optical Lab or Lens SupplierName* Phone*Account No*Name* Phone*Account No*Name* Phone*Account No*I hereby certify that the above information is true and correct and is provided for the purpose of obtaining credit. I,* hereby authorize K-Mars Optical. to use the information provided here to contact the sources listed above to verify all the necessary information about my business.Owner’s signature* Reset signature Signature locked. Reset to sign again Date* MM slash DD slash YYYY Owner’s name* First (no titles please)Owner’s social security number How did you hear about us? Mail Email Telemarketing Referral Name of Referral
