Please complete the entire form for us to process the order.

Full Name*

First Last

Date of Birth*

Phone*

Email*

How many contacts would you like to order ( 1 year, 6 months, 90 pairs)?*

Choose your method of delivery:*

Address*

Street Address Address Line 2 City Province Postal Code

For your convenience, our office takes credit card payments via Visa and Mastercard.

All orders require payment before they can be ordered in.

Credit Card Type:*

Visa or Mastercard only.

Card Number:*

Expiration Date:*

Verification Number on Back:*

Please advise us of any special requests.

Would you like us to email you a receipt?

CAPTCHA