Credit Request

Your Go-To 24 Hour AR Uncut Lab

Optogenics is pleased to make your credit requests easier. Upon submission of this form, our team will work to get your credit moving through our system. If there are any issues or questions, we will reach out to you for further assistance.

* :
Please enter account name
* :
Please enter account number
* :
Please enter contact name
* :
Please enter contact phone.
* :
Please enter contact email.
* :
Please enter the ID#.
* :
Please select Reason for Credit.
:
Please enter comments