Get Essilor Laboratories Of America Charge Authorization Form - Das Iowa

Filling out the Essilor Laboratories of America Charge Authorization Form - Das Iowa online is a straightforward process. This guide provides detailed steps to ensure that you complete the form accurately and efficiently.

Follow the steps to successfully complete the form online.

1. Click the ‘Get Form’ button to access and open the charge authorization form online.
2. Begin by filling in the 'Account Name' and 'Account No. (11 Digit)' fields. Ensure that the information matches what is on your account to avoid processing delays.
3. In the 'Patient Name' field, enter the name of the individual receiving the services or products. This is the person associated with the order.
4. If the cardholder is different from the patient, fill in the 'Card Holder Name' section with the appropriate details.
5. Complete the 'Card Holder Mailing Address' and ensure you include the city, state, and zip code to facilitate accurate billing.
6. Input the 'Card Number' and 'Exp. Date' accurately, making sure the card details are clear and correct to avoid transaction issues.
7. Provide the 'Card Holder Phone Number' to be contacted for any follow-up concerning the transaction or order.
8. Estimate the amount to charge in the 'Estimated Amount to Charge $' field. Ensure this figure aligns with the purchase details.
9. If you would like to receive a receipt via email or fax, fill in the 'Email or Fax info for receipt' section. If not, you may leave this blank.
10. Double-check all fields for accuracy, as every field on this form is required. Leaving any section empty will result in delays in processing your order.
11. After completing all sections, review your entries once again. If all information is accurate, you may proceed to save changes, download, print, or share the completed form as needed.

Complete your forms online today for a seamless experience!