Copy of Order Contact Lenses

Express Order Contact Lenses
STEP 1: Patient Information First Name: Last Name: Phone Number:	STEP 2: Order Information
STEP 3: Select Payment Information Credit Card Payment Upon Receipt Credit Card Type: Credit Card Number: Exp: Month: Year:	Additional Comments:
IMPORTANT: You must click on the "submit" button below, or your order will not be processed. We will contact you for pick up as soon as we receive your lenses, or if there is any question about your order.

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