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 CAPTCHANameThis field is for validation purposes and should be left unchanged.
