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YOUR PURCHASE DETAILS

To start your claim process, please tell us about your purchase.

* Mandatory fields

*Date of purchase is required

*Optometrist name is required

 

*Retailer location is required

$0

Uploading...please be patient. Your image size or internet speed may impact the time to upload.
 Image Uploaded
Note: The Purchase Receipt must clearly show retailer name, location, date, qualifying product(s) purchased and price paid.

*Upload is required (JPG, PNG, GIF or PDF formats only)

Please confirm you are not a robot

  • Please ensure a clear sharp image
  • Start with a receipt flat, without folds or wrinkles
  • If document, ensure it's flat, without folds or wrinkles.
  • Please keep your phone or camera flat and steady, to take a sharp and bright image. OK, GOT IT