BECOME AN AGENT

CERTIFIED INSURANCE AGENTS

Licensed Dispensing Opticians...This is Your Opportunity To Grow! Become a Certified Insurance Agent (C.I.A.) with OM2000 VISION Insurance. We specialize in 100% Vision Coverage Plans for the Optical Industry and Opticians are a Perfect Fit. Help us register 1.6 million new members with eye care needs worldwide and GROW WITH US! This form starts your journey with OM2000 VISION WORLDWIDE.
1) Who Referred You?

Name:Location
2) ENTER PROFILE PHOTO UPLOAD: For Agent Registry

Photo upload: (400 -1,000 pixels) Professional image only. OM2000 VISION INSURANCE has the right to refuse non-professional images that do not meet the qualification of the OM2000 VISION professional environment. OM2000 VISION has the right to promote such images on its web portal as www.om2000vision.com and any social media network associated with the OM2000 VISION brand for marketing promotions only.
3) File Upload*

Cancelof
4) Enter your full name*

First NameLast Name
5) Enter your email address*
example@example.com
6) Please add a short bio of who you are and your retail optical experience?*
7) Are you located in the USA?*

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaIdahoIndianaIllinoisIowaKansasKentuckyLouisianaMarylandMassachusettsMichiganMississippiNew JerseyNew YorkNorth CarolinaPennsylvaniaTennesseeTexasVirginaWashington D.C.Washington StateNone of the above
8) Are you located in the UK?*

BirminghamEast EnglandEnglandLiverpoolLondonManchesterNorth West of EnglandNorthern IrelandScotlandSoutheast of EnglandSouthwest of EnglandSouthwest IrelandWalesWest Midland of EnglandYorkshireNone of the above
9) Are you located in CANADA?*

AlbertaBristish ColumbiaManitopaNew BrunswickOntarioSaskatchewanQuebecNone of the above
10) Are you located in North America?*

BahamasBarbadosCosta RicaDominican republicGrenadaHondurasJamaicaMexicoTrinidad & TabogoNone of the above
11) Are you located in South America?*

ArgentinaBrazilChileColombiaEcuadorGuyanaPeruVenezulaNone of the Above
12) Are you located Internationally?*

AustraliaBeninBurkinaCameroonChinaCubaEl SalvadorGambiaGhanaGuatemalaFranceHaitiIndiaItalyIvory CoastJapanLiberiaMalaysiaMaiMozambiqueNigerNigeriaSaudi ArabiaSenegalSierra LeoneSignaporeSouth AfricaThailandTOGOTokyoUnited EmiratesNone of the Above
13) Do you represent an insurance agency in the optical field?*

YesNoNot sure
14) What is your qualification?*

Licensed OpticianCertified Eye Wear ConsultantCertified Ophthalmic TechnicianOptical Sales and MarketingOther Optical Retail ExperienceNone of the above
15) What is your availability*

Full-timePart-timeNot sure
16) When are you available to start work?*

ImmediatelyIn 2 weeksNegotiablenot sure
* Your signature completes this form. Due to the high volume of submissions please allow up to 24 hrs to receive a confirmation on approvals. WE ARE OM2000 VISION INSURANCE. We Are Different!*

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OM2000 VISION, LLC reserves the right to be selective. Emails are not shared with outside or third parties without the written consent of it's owner. All rights reserved. Copyright 2025-2026. Thank you for your cooperation. OM2000 VISION Management.
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CERTIFIED INSURANCE AGENTS