Hilco Vision + Mainline Optical Customer Account Transition

Hilco Vision + mainline optical

New & Existing Customer Registration
By completing this registration form, your practice will:
- Maintain uninterrupted access to Hilco Vision products and brands
- Connect directly with Mainline Optical Connections’ experienced sales and support team
- Gain access to future ordering and account services through Mainline
Once submitted, the Mainline team will review your information and follow up with account confirmation and next steps.
What best describes you as a Customer?
No action required. The full Hilco Vision product catalogue will be accessible through your existing Mainline account.
Customer information

Please fill out the following information
What is your Hilco Vision Customer Account Number
Click the "person" icon in the top right corner to view acct. info
What is your Mainline Optical Customer Account Number
Name of Practice
Contact Name
Email Address
example@example.com
Contact Number

Country CodePhone Number
Billing / Invoice Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Shipping / Delivery Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is your store based in Ireland?
Consent to share customer data
Signature
Date

MonthDayYear
Date
Should be Empty:

Hilco Vision + mainline optical