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 Online Since 1997
 

 

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Freshlook Contacts
~ Colors
~ Colorblends
~ Dimensions

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Secure Order Form
(Colors, Colorblends, & Dimensions)

 
 
 

For Freshlook Colorblends and
Freshlook Colors

 

Least Eye Color Change - Selected by the pair

Blue Colors   
Green Colors 
Violet Colors 
Gray Colorblends 
Amethyst Colorblends 
 

Moderate Eye Color Change - Selected by the pair

Hazel Colors   
Blue Colorblends 
Green Colorblends 
Brown Colorblends 
Honey Colorblends 
 

Most Eye Color Change - Selected by the pair

Turquoise Colorblends   
Pure Hazel Colorblends 
True Sapphire Colorblends 
 

Latest Colorblends - Selected by the pair

Sterling Gray Colorblends   
Brilliant Blue Colorblends 
Gemstone Green Colorblends 
 

Freshlook Dimensions - Select by the pair

Note: Do not order the Dimensions if you have naturally brown colored eyes.
Instead of changing eye color Dimension lenses only add color to naturally
light colored eyes, such as hazel, green or blue eyes.
 

Pacific Blue Dimensions  
 
Caribbean Aqua Dimensions  
Sea Green Dimensions  
 
*Enter total number of pairs
 
Enter number of plastic lens  
storage cases  



Prescription Information



Right Eye (OD)

Left Eye (OS)
Enter your sphere/power
  (Range from + 6.00 to - 8.00 )
   (0.00 = no power)
Base Curve (BC)
  (Only available in median/8.6)

median/8.6

median/8.6
Diameter (DIA)
  (Only available in 14.5)

14.5

14.5

* What is your natural eye color?


*Are you a returning customer?

If New Customer, enter your doctor or provider's name.


If New Customer, enter your doctor or provider's phone number and besure to include the area code.


  Last exam date

 

Shipping Information

Notice: Processing your order 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
* Enter First Name
* Enter Last Name
Enter birth date if under eighteen
* Enter Delivery Address, and besure to include Apt # and Suite # if applicable
* City
* State/Province
* Zip Code / 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
 
Who may we thank for referring you to us?
Enter friend's name here
 

Billing Information

 
Choose your type of payment: Credit Card  (fill in below)
Personal Check
Money Order
not sure
Notice: If you are paying by check or money order, we need to receive your
payment before shipping out your order.
 
If paying by check, please allow an additional two weeks time for your check
to clear the bank before your order will be shipped.
 

Credit Card Information:

Type of Credit Card to use
Credit Card Number (include spaces)
(example: 1234  4321  1234  4321)

Enter your credit card # again,
to show it was correct

Credit Card Expiration Date
Cardholder's Name on Credit Card
Enter the Security Code (3-4 digits) or the 800# on the back of card
 
If your credit card's billing address does not match the shipping
address above, then please supply the credit card's billing
address in the area below.
 
Address
City
State/Province
Zip/Postal Code
Country
 

Additional Information

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

 
 
 
Home Page | To Order Contact Lenses! | Discount Prices
Our Stock of Contacts | Colored Images | Free Offer Available
Payment Shipping Options | Wearing Instructions
Frequent Questions | Our Return Policy | International Delays
Contact Us Online | Our Sitemap
Copyright © 1997 - 2017 Colored Contacts LLC. All Rights Reserved