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Primary Contact Information
First Name
Last Name
Email
Phone Number
Store Information
Business Name
Website
Address Line 1
Address Line 2
District
Select
Alappey
Calicut
Ernakulam
Idukki
Kannur
Kasaragodu
Kollam
Kottayam
Malappuram
Palakkadu
Pathanamthitta
Thiruvananthapuram
Thrissur
Wayanadu
State
Select
Kerala
Country
Select
India
Store Email
Store Phone Number
Without country Code, Only 10 digits number
Date of Establishment
Additional Information
Tell us about your Company
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Other
Partneship
Private Limited Company
Proprietorship
GSTN Registered
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Yes
No
GSTN
Store Type
(Choose multiple if applicable)
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Hospital / Clinic
Optical Lab
Retail and Wholesale
Retail Opticians
Wholesaler
Type of work to be ordered from Drx Lab*(required)
(Choose multiple if applicable)
Select
Edged & Mounted Work
Low Vision Products
Rx Uncut / Stock Lenses
Semi Finished Products
Courier service you are currently using / Servicing in your area
(Choose multiple if applicable)
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Blue Dart
DTDC
FedEx
Other
Professional courier
Speed & Safe
How did you hear about Drx Lab
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From other Labs
From wholesaler
Other opticians
Web search
Preferred ordering method
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Email
Mobile App
Online
Phone
WhatsApp
Questions / Comments
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