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Would you like to reorder the same lenses, or order the new lenses you are trying? *
Please reorder the same brand that I purchased the last time Please order the new lenses that I am trying I am interesed in trying a complimentary pair of new lenses

Contact lens companies release new designs every year. It would be our pleasure to book a complimentary test drive of the latest lens materials.
How many boxes of lenses would you like? Remember, you save $$ when you purchase a 1 year supply. *
4 boxes 2 boxes a different supply - see comments section below

Many Contact Lens companies provide a mail in rebate when you order a minimum number of boxes. Ask us for details.
Would you like to order Contact Lens Solution with your lens supply? *
Yes! ......I like to save money. No thanks. Not this time.

There is additional savings when you bundle your solutions together with your lenses!
Name * First Last
Email *
Phone Number ### - ### - ####
Please give us a phone number that we can reach you during business hours. (Iin case we need to speak with you.)
Pick up/Delivery Options *
I will come to the office to pick up my lenses Please ship to my home address - shipping fee may apply Please ship to my office address - shipping fee may apply

Tell us which way is the most convenient for you to receive your new supply of contact lenses.
Shipping Address, if different from home address.

You may be eligible for free shipping if you order a one year supply of contact lenses. Certain minimum lens order required. Ask us for details.
Additional Comments/Special Requests

Any questions or concerns? Ask us here.
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