PLEASE NOTE: All prescriptions must be verified. Please click the "Email Us/Send RX" button above to send a scan or photo of it or by fax to (877) 480-4644. 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 for you. 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 we cannot ship your order. 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.

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Billing Information     First Name :   Last Name :   Company or In Care Of Name :   Address Line 1 :   Address Line 2 :   City :   State : (USA) Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland and Labrador North Carolina North Dakota Northwest Territories Nova Scotia Nunavut Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Yukon Outside of USA and Canada   Custom State / Province : (ONLY if outside USA and Canada)   Zip Code :   Country : United States American Samoa Canada Guam Marshall Islands Micronesia, Federated States Of Northern Mariana Islands Palau Puerto Rico St. John St. Thomas United States Minor Outlying Islands Virgin Islands (U.S.)   Phone Number :

Shipping Address     Shipping address is the same as billing   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) Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland and Labrador North Carolina North Dakota Northwest Territories Nova Scotia Nunavut Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Yukon Outside of USA and Canada   Or Custom State / Province : (ONLY if outside USA and Canada)   ZIP Code :   Country : United States American Samoa Canada Guam Marshall Islands Micronesia, Federated States Of Northern Mariana Islands Palau Puerto Rico St. John St. Thomas United States Minor Outlying Islands Virgin Islands (U.S.)

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? : Product Updates Our Newsletter   E-mail format : HTML Messages Text Messages   How Did You Find Our Site : ------ Amazon Google Friend Doctor Other

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: ANY AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY 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)

Search Results - Click on Doctor/Store Name to Fill in Boxes Above Name Address City State Zip Phone

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