Contacts & Fittings

You must have had a complete eye exam within the past twelve months to order contact lenses.

Please complete all required fields below. Orders received after 2 pm will be placed the following business day.

Please check the required fields

1. Full Name  
2. Street  
3. City  
4. State  
5. Zip  
6. Preferred Phone Number  
7. Alt Phone  
8. Email  
9. Preferred Contact  
   Email
   Phone
   
10. Month of Birth  
    Select Month January February March April May June July August September October November December
11. Quantity  
    Choose Your Quantity 3 Month Supply 6 Month Supply 12 Month Supply Yearly Lenses
12. Which Eye  
    Select Eye Left Eye Right Eye Both
13. Comments/Questions?  
14. Mail or Pickup?  
    Mail Them To Me : ($7 for less than 6 months supply)
    I'll Pick Them Up
    
15. Security Code: *
    Reload Image
    
16.