Contact Lenses On Sale



Secure Order Form

Four Box Minimun on all Orders

Freshlook ColorBlends
(6 lenses per box) -


Select boxes for each eye
  Right Eye Left Eye  
Amethyst ColorBlends -
Blue ColorBlends -
Brown ColorBlends -
Gray ColorBlends -
Green ColorBlends -
Honey ColorBlends -
Pure Hazel ColorBlends -
True Sapphire ColorBlends -
Turquoise ColorBlends -
Gemstone Green Colorblends -
Sterling Gray Colorblends -
Brilliant Blue Colorblends -
Freshlook Colors
(6 lenses per box) -


Select boxes for each eye
  Right Eye Left Eye  
Blue Colors -
Green Colors -
Hazel Colors -
Violet Colors -

Select your sale price for Colorblends and Colors by entering
the total number of boxes selected. (For example: if you select
2 box for the right eye and 2 box for left eye, then select 4 boxes.)
* Total number of boxes selected

Prescription Information

Right Eye (OD)

Left Eye (OS)
Enter your sphere(power)
  (Range from + 6.00 to - 8.00 )
  (without vision correction = 0.00 )
Base Curve (BC)
  (Only available in median/8.6)


Diameter (DIA)
  (Only available in 14.5)



* What is your natural eye color?

* Are you a returning customer?

* If new customer, enter your doctor or provider's name

*Also, enter your doctor or provider's phone number and besure to include the area code.

Notice: If you do not know the above phone number, try doing a Google search entering your provider's professional specialty, provider's last name, city, state, area code. Professional specialty keywords to use: MD, OD, physican, ophthalmologist, optometrist, optician, laser surgeon, and lasik.

Special Exception: packages going outside the USA (including APO's), the doctor information is not required. Just enter the word "exempt" in the above required fields.

  Last exam date


Shipping Information

Please Notice: Processing may take 2 to 3 days and generally includes verifying the prescription and the credit card address, submitting the credit card charges, obtaining the lenses, packaging the order and finally putting it in the mail.
* Select shipping method
* First name
* Last name
If under 18 yrs, enter birth date
* Address
* City
* State/Province
* Zip/Postal Code
If outside USA, enter Country
Home Phone with Area Code
Work Phone with Area Code
Cell Phone with Area Code
* Enter your email address
Whom may we thank for referring you to us?
Enter friend's name

Billing Information

Choose your type of payment: Credit Card  (fill in below)
Personal Check
Money Order
Not Sure
Notice: For customers paying by check or money order, we must receive
your payment before we will send your order.   Also, for customers paying
by check, you must allow an additional 2 weeks so that your check can
clear the bank before we send out your shipment.

Credit Card Information:

Type of Credit Card
Credit Card Number (include spaces)
(example: xxxx  xxxx  xxxx  xxxx)

Enter your credit card # again,
to confirm it was entered correctly

Credit Card Expiration Date
Cardholder's Name on Credit Card
Enter the Security Code (3-4 digits)
(If the credit card's billing address does not match the shipping address above,
then please supply the credit card's billing address below)
Zip/Postal Code

Additional Information

Please provide any additional information in the area provided below.
If you would like confirmation of your order, please provide your e-mail address.


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