If you would like to order contact lenses, please fill out the forms below, and we will contact you by phone or email to complete your order.
If your order is urgent, please call us instead at 1-800-873-7393.
* Your Name:
* Your Email Address:
* Your Phone Number:
* Your Prescription:
It should be in the DCEA files already I will send it in from my doctor
Note: If you have ever bought contacts from us before, then you don't need to fill this out. We will have your brand on file.
Brand:
Quantity:
* Address Line 1:
* Address Line 2:
* City:
* State:
WI -- AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
* Zip Code:
If there is any other information you think we should know, please enter it here:
Enter any other information here...
