Get Application For Registration To Dispense Contact Lenses By Mail - Ksbha

This guide provides clear and supportive instructions for completing the Application For Registration To Dispense Contact Lenses By Mail - Ksbha online. Following these steps will help ensure that your application is filled out correctly and submitted successfully.

Follow the steps to complete your application effectively.

1. Use the 'Get Form' button to access the application, which will open it in a suitable format for editing.
2. Begin by entering the business name and any other names used, including trade names. Ensure all information is accurate and complete.
3. Fill in the address section with your business mailing address, including the street, city, county, state, and zip code. Repeat for additional addresses if necessary.
4. Provide a valid email address and website, as well as the dispensing facility name if applicable.
5. Enter your phone number, including area code, and provide fax and toll-free numbers for consumers.
6. Indicate the type of business by checking the appropriate box, such as general corporation or limited liability company.
7. List the corporate officers by entering the names and residential addresses for the president, secretary, and treasurer. Include all relevant details.
8. Designate an agent for service of legal process by providing their name and residential address.
9. List individuals responsible for overseeing contact lens dispensing in Kansas, including their name, title, and address. Attach a separate list if necessary.
10. Answer whether the state of your dispensing facility requires a license to dispense contact lenses, and provide license details if applicable.
11. Indicate your regular hours of operation for all days of the week.
12. Acknowledge and certify compliance with the terms and conditions stated in the application. This may require a signature, printed name, and date.
13. Complete the fees section by including the payment information for the registration fee, ensuring it is payable to the Kansas State Board of Healing Arts.
14. Once all sections of the form are completed, review your entries for accuracy. Save your changes, and choose to download, print, or share the completed form as needed.

Start your application process today to ensure timely registration for dispensing contact lenses by mail.