Wufoo

Order Form

By filling up this form
- you have confirmed your order and no backing out is allowed once this order form is being posted.
- you have agreed to our Terms and conditions

Name * First Last
Email *
Phone Number *
Gender *
Female Male
Contact Lens Brand *

e.g. GEO
Lens description *

Your choice's description.
Please type in in this format:
No.) Lens Name (degree)
for example:
1) Angel Color Blue (-1.00)
2) Nudy Quarter Gray (-2.50)
etc.

For a different Brand, please submit in a different form.
Total Quantity *

e.g. 2 pairs
Price Calculation *
Lens Price + Postage fee(if any) x Quantity

Type in the calculation of the total price here. For example:
(SG$20.00 + SG$1.00)x2
Total Price * $ Dollars . Cents
total price from the calculation above
Mode of Payment and collection *

Type in your preferred mode of payment and collection. To view what we offer, visit our Terms and Conditions Page.
Please type in this format:
Payment:
Collection:
Do Not Fill This Out