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PLEASE NOTE: All prescriptions must be verified. You may fax a copy to (206) 339-0513 or send a scan or picture of it to buycontacts@yahoo.com. If you don't have a copy of your prescription simply enter your doctor or store's phone number or enough information so we may find the number (Please Help: "Walmart, Dallas" isn't enough). If you are shipping an order to the U.S. and do not have a U.S. doctor we require a copy of the non-US prescription. If you can not provide a copy of the non-US prescription your order can not ship and will be cancelled. We cannot ship orders entered with an incorrect credit or debit card billing address. If you have recently moved please use your old address if you haven't updated it.

All required fields are bold

Billing Information
 
  First Name :
  Last Name :
  Company or In Care Of Name :
  Address Line 1 :
  Address Line 2 :
  City :
  State :
(USA)
  Custom State / Province :
(ONLY if outside USA and Canada)
  Zip Code :
  Country :
  Phone Number :
 
Shipping Address
   

 
Please check this box if your shipping information is the same as billing.
 
  Name :
  Company or In Care Of Name :
  Address Line 1 :
  Address Line 2 :
  City :
  State :
(USA)
  Or Custom State / Province :
(ONLY if outside USA and Canada)
  ZIP Code :
  Country :
 
Account Information
 
  Username :
(Minimum 4 characters or you may use your email address)
  Password :
(Minimum 6 characters)
  Confirm Password :
  Email Address : (Remember to check your spam folder) :
  Would you like to receive? :
  E-mail format :
  How Did You Find Our Site :
 
Rx Information
 

Please use the "Doctor Lookup" below to find your doctor or store information. If you cannot find your doctor or store in the Doctor Lookup please just type the information in the text boxes to the left. We do not need a copy of your prescription only the doctor's phone number or enough information to find the phone number for you. If there several chain stores in your city we need the specific store phone or location please. Incorrect or missing doctor or store information will delay your order.

Doctor Lookup
Doctor/Store Name:
City:
State:
Zip:
  Patient 1 Name:
(If yourself you may leave blank)
  Patient 1 Doctor or Store Name:
  Patient 1 Doctor or Store City & State:
  Patient 1 Doctor or Store Phone Number:
  Patient 1 Name of Contact Lens Purchased:
(Example: Biofinity, Oasys)
  Patient 2 Name:
  Patient 2 Doctor or Store Name:
  Patient 2 Doctor or Store City & State:
  Patient 2 Doctor or Store Phone Number:
  Patient 2 Name of Contact Lens Purchased:
(Example: Biofinity, Oasys. If both same enter powers)
  Patient 3 Name:
  Patient 3 Doctor or Store Name:
  Patient 3 Doctor or Store City & State:
  Patient 3 Doctor or Store Phone Number:
  Patient 3 Name of Contact Lens Purchased:
(If any are the same brand please enter brand name & powers)
  Patient 4 Name:
  Patient 4 Doctor or Store Name:
  Patient 4 Doctor or Store City & State
  Patient 4 Doctor or Store Phone Number:
  Patient 4 Name of Contact Lens Purchased:
(If any are the same brand please enter brand name & powers)


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