It’s easy to apply for Red Tray membership! Just complete the short application below, click ‘Next’ to select the suppliers you wish to set up to bill through Red Tray, then click ‘Submit’ to send your information for processing.

Or, if you prefer, call 800.416.7676 for a fax-back application.

If you have any questions or need assistance, just call Red Tray Member Services at 800.416.7676.


   
Membership Application
 
All Fields Required
   
Principal Owner's Name
   
Title OD    MD    Optician  
   
Years In Practice   Years At This Location
   
Date Of Birth - - (mm-dd-yy)
   
Practice Name
   
“Bill To” Name
   
E-Mail Address
   
Office Phone Number (no dashes)
   
Office Fax Number (optional) (no dashes)
   
Type Of Practice: Solo OD Group OD Optician
Solo MD Group MD MD/OD
   
   
Social Security # (no dashes)
   
Federal Tax ID # (no dashes)
   
Billing Address  
   
Street/P.O.Box
   
City
   
State Zip Code
   
Shipping Address (if different from above)
   
Street
   
City
   
State Zip Code
   
Owner’s Home Address (required for credit verification)
   
Street/P.O.Box
   
City
   
State Zip Code
   
Home Phone Number (no dashes)
   
Level of monthly credit you wish approved: $100-$999
$1,000-$1,999
$2,000-$3,999
$4,000+
   
Do you currently belong to any buying groups? Yes    No
   
How did you hear
about us?
   
Name of specific source:
   

   
Terms And Conditions
   
   
First Name   Middle Initial   Last Name
 
 
 
First Name   Middle Initial   Last Name