Purchase Our Colored Contacts Lenses using our Secure Order Form

Online Since 1997

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

	Right Eye (OD)	Left Eye (OS)
Prescription Information
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.