Applicants for registration as an out of state contact lens dispenser shall pay the registration fees required by Plc 1001.08 and Plc 1002.37 and complete and submit to the OPLC the “Application for Registration as an Out of State Contact Lens Dispenser” by providing the following information:

1. (a) The name and address of the business;
2. (b) The telephone number of the business;
3. (c) The type of business organization and the names and titles of all principal owners or officers of the business;
4. (d) The names and business addresses of all subsidiaries, branches, or divisions of the business which provide spectacles or contact lenses for retail sale or which provide optometric or ophthalmic care;
5. (e) Whether or not the business is in compliance with all applicable laws and regulations in the state in which it is physically located;
6. (f) If the answer to (e) above is in the negative, provide a detailed explanation of the no answer;
7. (g) Whether or not the business will comply with all applicable laws and regulations in the conduct of its business in New Hampshire;
8. (h) If the answer to (g) above is in the negative, provide a detailed explanation of the no answer; and
9. (i) The signature and date of signing of the principal owner or officer of the business.

Source. #6098, eff 10-1-95; amd by #6717, eff 3-24-98, EXPIRED: 3-24-06 New. #9342, eff 12-9-08, EXPIRED: 12-9-16 New. #12108, INTERIM, eff 2-21-17, EXPIRED: 8-20-17 New. #12383, eff 9-16-17; ss by #14242, eff 6-21-25, EXPIRES: 6-21-35