lombartinstrument.com
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Submitted URL: https://email.advancingeyecare.com/767I-5X51-2L74CL-5G31Z-1/c.aspx
Effective URL: https://lombartinstrument.com/request-a-quote-eblast/?product_name_1649100528807=Lasers-Promo&utm_campaign=276229_12.13_Lombar...
Submission: On December 13 via manual from US — Scanned from DE
Effective URL: https://lombartinstrument.com/request-a-quote-eblast/?product_name_1649100528807=Lasers-Promo&utm_campaign=276229_12.13_Lombar...
Submission: On December 13 via manual from US — Scanned from DE
Form analysis 3 forms found in the DOM
GET /products/
<form action="/products/" method="get" class="bc-form">
<div class="bc-product-archive__search_in_header">
<label for="s" class="u-bc-visual-hide">Search</label>
<input type="search" name="s" value="" placeholder="Search">
<input type="hidden" name="bc-sort" value="title_asc">
<input type="hidden" name="bigcommerce_category" value="0">
<input type="hidden" name="bigcommerce_brand" value="0">
<input type="image" name="Submit" alt="Submit" src="/wp-content/uploads/2022/02/lombart-web_lombart-arrow-left.svg">
<span class="u-bc-visual-hide">Search</span>
</div>
</form>GET /products/
<form action="/products/" method="get" class="bc-form">
<div class="bc-product-archive__search_in_header">
<label for="s" class="u-bc-visual-hide">Search</label>
<input type="search" name="s" value="" placeholder="Search for a product">
<input type="hidden" name="bc-sort" value="title_asc">
<input type="hidden" name="bigcommerce_category" value="0">
<input type="hidden" name="bigcommerce_brand" value="0">
<input type="image" name="Submit" alt="Submit" src="/wp-content/uploads/2022/02/lombart-web_lombart-arrow-left.svg">
<span class="u-bc-visual-hide">Search</span>
</div>
</form><form>
<div>
<div class="nf-before-form-content"><nf-section>
<div class="nf-form-fields-required">Fields marked with <span style="color: #e80000">*</span> are required</div>
</nf-section></div>
<div class="nf-form-content "><nf-rows-wrap>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 50%;">
<nf-fields><nf-field>
<div id="nf-field-197-container" class="nf-field-container firstname-container label-above ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-197-wrap" class="field-wrap firstname-wrap" data-field-id="197">
<div class="nf-field-label"><label for="nf-field-197" id="nf-label-field-197" class="">First Name <span class="ninja-forms-req-symbol">*</span> </label></div>
<div class="nf-field-element">
<input type="text" value="" class="ninja-forms-field nf-element" id="nf-field-197" name="fname" autocomplete="given-name" aria-invalid="false" aria-describedby="nf-error-197" aria-labelledby="nf-label-field-197" required="">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-197" class="nf-error-wrap nf-error" role="alert"></div>
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</div>
</nf-field></nf-fields>
</div>
<div class="nf-cell" style="width: 50%;">
<nf-fields><nf-field>
<div id="nf-field-198-container" class="nf-field-container lastname-container label-above ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-198-wrap" class="field-wrap lastname-wrap" data-field-id="198">
<div class="nf-field-label"><label for="nf-field-198" id="nf-label-field-198" class="">Last Name <span class="ninja-forms-req-symbol">*</span> </label></div>
<div class="nf-field-element">
<input type="text" value="" class="ninja-forms-field nf-element" id="nf-field-198" name="lname" autocomplete="family-name" aria-invalid="false" aria-describedby="nf-error-198" aria-labelledby="nf-label-field-198"
required="">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-198" class="nf-error-wrap nf-error" role="alert"></div>
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<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-199-container" class="nf-field-container textbox-container label-above ">
<div class="nf-before-field"><nf-section>
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<div class="nf-field">
<div id="nf-field-199-wrap" class="field-wrap textbox-wrap" data-field-id="199">
<div class="nf-field-label"><label for="nf-field-199" id="nf-label-field-199" class="">Company <span class="ninja-forms-req-symbol">*</span> </label></div>
<div class="nf-field-element">
<input type="text" value="" class="ninja-forms-field nf-element" id="nf-field-199" name="nf-field-199" aria-invalid="false" aria-describedby="nf-error-199" aria-labelledby="nf-label-field-199" required="">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-199" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 33%;">
<nf-fields><nf-field>
<div id="nf-field-200-container" class="nf-field-container email-container label-above ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-200-wrap" class="field-wrap email-wrap" data-field-id="200">
<div class="nf-field-label"><label for="nf-field-200" id="nf-label-field-200" class="">Email Address <span class="ninja-forms-req-symbol">*</span> </label></div>
<div class="nf-field-element">
<input type="email" value="" class="ninja-forms-field nf-element" id="nf-field-200" name="email" autocomplete="email" aria-invalid="false" aria-describedby="nf-error-200" aria-labelledby="nf-label-field-200" required="">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-200" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
<div class="nf-cell" style="width: 33%;">
<nf-fields><nf-field>
<div id="nf-field-201-container" class="nf-field-container phone-container label-above textbox-container">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-201-wrap" class="field-wrap phone-wrap textbox-wrap" data-field-id="201">
<div class="nf-field-label"><label for="nf-field-201" id="nf-label-field-201" class="">Phone Number <span class="ninja-forms-req-symbol">*</span> </label></div>
<div class="nf-field-element">
<input type="tel" value="" class="ninja-forms-field nf-element" id="nf-field-201" name="phone" autocomplete="tel" aria-invalid="false" aria-describedby="nf-error-201" aria-labelledby="nf-label-field-201" required="">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-201" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
<div class="nf-cell" style="width: 33%;">
<nf-fields><nf-field>
<div id="nf-field-203-container" class="nf-field-container zip-container label-above ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-203-wrap" class="field-wrap zip-wrap" data-field-id="203">
<div class="nf-field-label"><label for="nf-field-203" id="nf-label-field-203" class="">Zip <span class="ninja-forms-req-symbol">*</span> </label></div>
<div class="nf-field-element">
<input type="text" value="" class="ninja-forms-field nf-element" id="nf-field-203" name="zip" autocomplete="postal-code" aria-invalid="false" aria-describedby="nf-error-203" aria-labelledby="nf-label-field-203" required="">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"> 5 of 5 Character(s) left </div>
<div id="nf-error-203" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-218-container" class="nf-field-container textbox-container label-above ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-218-wrap" class="field-wrap textbox-wrap" data-field-id="218">
<div class="nf-field-label"><label for="nf-field-218" id="nf-label-field-218" class="">Product Name <span class="ninja-forms-req-symbol">*</span> </label></div>
<div class="nf-field-element">
<input type="text" value="Lasers-Promo" class="ninja-forms-field nf-element" id="nf-field-218" name="nf-field-218" aria-invalid="false" aria-describedby="nf-error-218" aria-labelledby="nf-label-field-218" required="">
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-218" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-204-container" class="nf-field-container textarea-container label-above ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-204-wrap" class="field-wrap textarea-wrap" data-field-id="204">
<div class="nf-field-label"><label for="nf-field-204" id="nf-label-field-204" class="">Additional Comments/Questions? </label></div>
<div class="nf-field-element">
<textarea id="nf-field-204" name="nf-field-204" aria-invalid="false" aria-describedby="nf-error-204" class="ninja-forms-field nf-element" aria-labelledby="nf-label-field-204"></textarea>
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-204" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-205-container" class="nf-field-container recaptcha-container label-above textbox-container">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-205-wrap" class="field-wrap recaptcha-wrap textbox-wrap" data-field-id="205">
<div class="nf-field-label"><label for="nf-field-205" id="nf-label-field-205" class="">Security </label></div>
<div class="nf-field-element">
<input id="nf-field-205" name="nf-field-205" class="ninja-forms-field nf-element" type="hidden" value="">
<div class="g-recaptcha" data-callback="nf_recaptcha_response_205" data-theme="light" data-sitekey="6LdvLwodAAAAAHdZdHMODi3cjxmgtzAOOkb4gF9v" data-fieldid="205">
<div style="width: 304px; height: 78px;">
<div><iframe title="reCAPTCHA"
src="https://www.google.com/recaptcha/api2/anchor?ar=1&k=6LdvLwodAAAAAHdZdHMODi3cjxmgtzAOOkb4gF9v&co=aHR0cHM6Ly9sb21iYXJ0aW5zdHJ1bWVudC5jb206NDQz&hl=de&v=pn3ro1xnhf4yB8qmnrhh9iD2&theme=light&size=normal&cb=55h48zjmvynt"
width="304" height="78" role="presentation" name="a-uleb984q4lf7" frameborder="0" scrolling="no"
sandbox="allow-forms allow-popups allow-same-origin allow-scripts allow-top-navigation allow-modals allow-popups-to-escape-sandbox"></iframe></div><textarea id="g-recaptcha-response" name="g-recaptcha-response"
class="g-recaptcha-response" style="width: 250px; height: 40px; border: 1px solid rgb(193, 193, 193); margin: 10px 25px; padding: 0px; resize: none; display: none;"></textarea>
</div><iframe style="display: none;"></iframe>
</div>
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-205" class="nf-error-wrap nf-error" role="alert"></div>
</nf-section></div>
</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-206-container" class="nf-field-container html-container label-above disclaimer ">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-206-wrap" class="field-wrap html-wrap" data-field-id="206">
<div class="nf-field-label"><label for="nf-field-206" id="nf-label-field-206" class="">HTML </label></div>
<div class="nf-field-element">
<b>By submitting this form I agree that Advancing Eyecare</b><span
style="font-family: docs-Calibri; font-size: 15px; white-space: pre-wrap;">™</span><b> may process my data in the manner described in the <a href="https://www.advancingeyecare.com/privacy-policy/" target="_blank">Privacy Policy</a>.</b>
</div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-206" class="nf-error-wrap nf-error" role="alert"></div>
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</div>
</nf-field></nf-fields>
</div>
</nf-cells>
</div>
<div class="nf-row">
<nf-cells>
<div class="nf-cell" style="width: 100%;">
<nf-fields><nf-field>
<div id="nf-field-202-container" class="nf-field-container submit-container label-above textbox-container">
<div class="nf-before-field"><nf-section>
</nf-section></div>
<div class="nf-field">
<div id="nf-field-202-wrap" class="field-wrap submit-wrap textbox-wrap" data-field-id="202">
<div class="nf-field-label"></div>
<div class="nf-field-element">
<input id="nf-field-202" class="ninja-forms-field nf-element " type="button" value="Submit">
</div>
<div class="nf-error-wrap"></div>
</div>
</div>
<div class="nf-after-field"><nf-section>
<div class="nf-input-limit"></div>
<div id="nf-error-202" class="nf-error-wrap nf-error" role="alert"></div>
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</nf-rows-wrap></div>
<div class="nf-after-form-content"><nf-section>
<div id="nf-form-errors-16" class="nf-form-errors" role="alert"><nf-errors></nf-errors></div>
<div class="nf-form-hp"><nf-section>
<label for="nf-field-hp-16" aria-hidden="true"> If you are a human seeing this field, please leave it empty. <input id="nf-field-hp-16" name="nf-field-hp" class="nf-element nf-field-hp" type="text" value="">
</label>
</nf-section></div>
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</div>
</form>Text Content
Skip to content Advancing Eyecare™ Alliance. Learn More Free Shipping on Orders over $179* Click here Search Search * Cart Menu * View Products * Promotions * Service * Repairs & Maintenance * Protection Plans * Sell / Trade Equipment * Students * Finance * News * About * About Us * Events * Government Request * Contact Lombart * Login * Request a Quote Lombart Instrument / Request a Quote Advancing Eyecare™ Alliance. Learn More FREE SHIPPING ON ONLINE ORDERS OVER $179* Click here Search Search * View Products * Promotions * Service * Repairs & Maintenance * Protection Plans * Sell / Trade Equipment * Students * Finance * News * About * About Us * Events * Government Request * Contact Lombart * Login * Request a Quote Menu * View Products * Promotions * Service * Repairs & Maintenance * Protection Plans * Sell / Trade Equipment * Students * Finance * News * About * About Us * Events * Government Request * Contact Lombart * Login * Request a Quote View Products REQUEST A QUOTE * Cart * Cart Lombart Instrument / Request a Quote REQUEST A QUOTE Lombart is dedicated to helping you find the right equipment to fit your practice. Simply fill out the form below and one of our experienced representatives will get back with you promptly with a quote. Notice: JavaScript is required for this content. Fields marked with * are required First Name * Last Name * Company * Email Address * Phone Number * Zip * 5 of 5 Character(s) left Product Name * Additional Comments/Questions? Security HTML By submitting this form I agree that Advancing Eyecare™ may process my data in the manner described in the Privacy Policy. If you are a human seeing this field, please leave it empty. A Division of Advancing Eyecare™ © 2022 Lombart Instrument, Inc. All Rights Reserved. 800-LOMBART | Email Us | Subscribe Account Information * Contact Lombart * Student Store Products & Services * Used & Pre-Owned Equipment * Promotions * Request a Quote * Repairs & Maintenance * Request a Catalog * Government Request Get to Know Lombart * About Us * News * Careers * Sitemap * Privacy Policy * Terms & Conditions * Site Map (Hidden, GB) Lombart Instrument is committed to keeping our site accessible to everyone. We welcome feedback on ways to improve the site’s accessibility so it is easy for everyone to navigate.