New User – Piazza Optical

Welcome to PIAZZA OPTICAL

Complete the following new user form. In this section you can access the necessary requirements to operate with us. We ask you to complete the following customer registration form so we can give you access to the site. If you have any concerns, please contact us.

First Name *

Last Name *

Country *

Phone Number

Street address *

Suite / Apt. Number *

City *

State *

Zip code *

Username *

User Email *

User Password *

Confirm Password *

Store Name / DBA *

Position in the Company *