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New Member Registration

Name*
First Last
Email*
Set your password*
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Phone*
Business Name*
Website URL*
Business Address*
Street Address City State ZIP Code
Are you currently a member of any alliance or buying group?*
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Which buying group(s) are you currently a member of?
Membership Agreement*
- I agree to Pivotal Group's Membership Agreement
Non-Disclosure Agreement*
- I agree to Pivotal Group's Non-Disclosure Agreement
Declaration of Non-Fraudulent Application*
- I declare under penalty of perjury (under the laws of the United States) that I am an optometry clinic or or independent optical dispensary, and that all information submitted with this application is accurate and true.
Electronic Signature*

Must be signed by the business owner or authorized user. NOTE: Your IP address is stored with this submission for the purposes of fraud prevention.
Signature
Please sign using your mouse or touch-screen device. NOTE: Your IP address is stored with this submission for the purposes of fraud prevention.

Being Independent Does Not Mean You’re Alone

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Overhaul your supply chain with equal-quality, profit-rich products that you can’t find anywhere else.

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Learn what the country’s most profitable optometrists are doing to dominate every region they operate in.

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New Member Registration

Being Independent Does Not Mean You’re Alone

Join Pivotal Group for Free Today to…