EyeglassCases.com Request for Information Thank you for visiting the EyeglassCases.com website. Please fill out this form, and a salesperson will contact you. For immediate service, call 1-800-556-7390. Be assured, your information will be used by our firm only. * required field * First Name * Last Name * Company/Store Name * Address Address * City * State * Zip   (U.S. or Canada only, please.) * Telephone * E-Mail address Fax * Type of Business Manufacturer Independent (Dr.)(OD)(OP) Retail Chain Importer Wholesaler Buying Group Student Other If "Other", what: * What type of cases are you interested in? * Projected order quanitity: Budget: Delivery deadlines: Comments or Questions