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Vision Proposal Request
Thank you for your interest in vision plans from Select Networks.
Below, you will find our Vision Proposal Request Form. Please print and fill out this form
in its entirety. You can then fax or mail the request in. Instructions are included on the
form. If you have any questions, you can contact Steve Ellingboe at 1-800-797-6282 ext. 4822.
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These documents are in PDF format. If you do not already have a
copy of Adobe Acrobat Reader you will need to
download a free copy now.
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