Contact Lenses On Sale



Secure Order Form

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 -
Freshlook Colors
(6 lenses per box) -


Select boxes for each eye
  Right Eye Left Eye  
Blue Colors -
Green Colors -
Hazel Colors -
Violet Colors -
Freshlook Dimensions
(6 lenses per box) -

Select boxes for each eye
  Right Eye Left Eye  
Caribbean Aqua Dimensions -
Pacific Blue Dimensions -
Sea Green Dimensions -

Select your sale price for Colorblends, Colors, & Dimensions by
entering the total number of boxes selected. (For example: if you select
1 box for the right eye and 1 box for left eye, then select 2 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

* 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.

OPTIONAL SURVEY: We Would Like To Know ...

1. What search engine did you use?
not sure
Another Search Engine

2. What keywords did you use for your search?
not sure, found by accident
The keywords:
Referred by a friend

3. About how many hours do you spend on average on the computer each day?
not sure
1-2 hours
3-5 hours
6-8 hours
9-11 hours
over 12 hours

4. While working on the computer, do you have any of the following eye symptoms: headaches, blurry vision, dryness of eyes, burning eyes, eyestrain, color distortion, and double vision?
not sure
no symptoms
1-2 of the symptoms
3-5 of the symptoms
6-7 symptoms

5. What is your age group?
not sure
60 an above
Thank you!


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