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For your convenience, we have provided you with the Vision Benefit claim form for Ford Motor Company hourly employees. You can use this claim form to file for Vision benefits, if you obtained services from a non-participating provider.

To print a copy of the form, click on the link, Application for Benefit Form or for directions on how to complete this form, click on Directions for Benefit Form. The file will launch using Adobe's Acrobat Reader.

If you do not have Adobe's Acrobat Reader 3.x or greater installed, click on the icon below to go to Adobe's site and download the reader for free

Go to Adobe's site to download the Reader.

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