Access Request Form
If you need to reactivate your account on, please provide the following:
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First Name *
Last Name *
WIN# / Employee Number *
Walmart Email Address *
Are you ABO or NCLE certified? *
ABO-NCLE Number (if applicable)
Providing this number will allow us to report credits earned to the ABO-NCLE automatically on your behalf.
State Licenses
If you hold a state license, please include the name of the state AND your license number, if applicable.
Vision Center Street Address *
Vision Center City *
Vision Center State *
Vision Center Zip Code *
Vision Center Phone Number *
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