2026 Digital Screen Upgrade Request Form

2026 Digital Screen Upgrade Request Form

Submit a request to upgrade your 32" screen to the new 2026 EL360 Digital Screen.
1. By submitting this registration, I confirm that I am the practice owner or I am authorized to act on behalf of the practice owner, and that this installation has been reviewed and approved by the practice owner or the authorized decision-maker of the practice.
2. Important: Please sign the agreement downloaded from the invitation email and upload it here.

Accepted file types: PDF, DOC, JPG, or PNG files.
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3. Select your role

Other
4. When we install the new screen, would you like us to remove the old screen you have?
See it in your space.

Scan to preview how the screen looks in your practice. The screen is displayed at true scale. If needed, pinch to zoom in or out to 100% to see the actual size.

Note: This AR visualization is for reference only. The actual screen features a more refined finish.
5. Select zone for installation
6. Luxottica account number (store ID)
7. Store/practice name
8. Contact name
9. Email
10. Phone number
11. Address
12. City
13. State (US) / province (Canada)
14. ZIP code (US) / postal code (Canada)
15. Country
16. Preferred language
Should be Empty: