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:

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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