Dealer Inquiry Form

Thank you for your interest in Optisan®. To become an Authorized Optisan Dealer complete the form below.

Fill out my online form.

You may alternately download and complete the Dealer Application PDF from the link below. Return the completed application together with a copy of your State Business/Reseller’s License to [email protected] or fax to (608) 612-0621.

Dealer Application PDF

You may also return by mail to the following address:

Optisan North America
Attention: Dealer Services
317 Forth Street South
Building 3-58
LaCrosse WI 54601