Keeler Rewards club - Enrollment form
Join the club. Get fabulous rewards!
Account number
*
Name of practice
*
Name of manager or physician
*
Phone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email of manager or physician (for order correspondence)
*
example@example.com
Email for rewards club statements (if different to above)
example@example.com
Signature of manager or physician
*
I would like to enroll in the Keeler rewards club to earn points with every clinical purchase, which can be collected and redeemed for brand new ophthalmic equipment. I understand I may be contacted occasionally with relevant program updates and can unsubscribe at any time.
I would like to opt in to receive occasional newsletters from Keeler with promotions, product news and availability. I understand my details will never be passed on to a third party and I can unsubscribe at any time.
Submit form - Enroll now
Submit form - Enroll now
Should be Empty: