The trial does not obligate your company to a contract or any commitment. We are happy to EARN your eyewear business with the quality and service of our program. Please complete this form to describe your initial program requirements. We will design and implement your business rules on a micro-website specifically to manage your Safety Eyewear Program. You can expect a follow up email with login instructions to your new website within 48 hours. DON'T WORRY ABOUT ANSWERING A QUESTION INCORRECTLY - you will have opportunities to review and refine your site.


Company Info

Benefits/Employee Data

Payroll Deduction Allowed

Lens Options

Registration Requirements

Your employees will self register on your site - create their own username and password however they cannot join the program until you approve their registration request. Would you like to collect additional details about their registration? (For example, do you want to require employee to select their location from a drop down option? Enter their employee ID? Select a department or billing #?

You will receive an email copy of this Enrollment form along with a follow up contact from your project leader. We look forward to launching your website within the next 2 days!

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