THIS FORM ONLY TAKES 5 MINUTES TO FILL OUT SAVING YOU LOTS OF MONEY. GUARANTEED! WHY NOT SAVE? THERE ARE NO GIMMICKS. YOUR NAME WILL NOT BE ADDED TO ANYONES MAILING LIST.

INSTRUCTIONS: PRINT THIS FORM!

GO TO YOUR DOCTOR'S OFFICE AND ASK FOR A WRITTEN PRESCRIPTION OF YOUR CONTACTS.  TELL THEM YOU WANT TO SHOP AROUND BEFORE YOU BUY. MAKE SURE THEY INCLUDE THE BASE CURVE AND DIAMETER OF THE CONTACTS! IF NOT, YOU HAVE AN EYEGLASS RX NOT A CONTACT LENS RX!

 FILL OUT THE FORM BELOW . WE WILL REPLY WITHIN 24 HOURS WITH A GUARANTEED LOWER PRICE! PLEASE DO NOT SEND MORE THAN 2 INQUIRIES. THANK YOU.

CUSTOMER INFORMATION: TAB TO NEXT FIELD.

*NAME: *(REQUIRED)

*E-MAIL ADDRESS: * (REQUIRED)

TELEPHONE:* * (REQUIRED)

CONTACT LENS QUOTE# 1

ENTER YOUR DOCTORS INFORMATION:

MANUFACTURER *(REQUIRED) EXAMPLE: VISTAKON

NAME OF CONTACTS * (REQUIRED) EXAMPLE: ACUVUE 2

POWER RIGHT * (REQUIRED) EXAMPLE: -2.00

POWER LEFT * (REQUIRED) EXAMPLE: -2.25

BASE CURVE (BC) * (REQUIRED) EXAMPLE: 8.4

DIAMETER * (REQUIRED) EXAMPLE: 14.0

PRICE OF CONTACT FROM YOUR DOCTOR *  (REQUIRED)  EXAMPLE: $155.00 (WOW!)

DOCTOR'S TELEPHONE:* * (REQUIRED)

E-MAIL ME NOW

CUSTOMER INFORMATION 2: TAB TO NEXT FIELD.

*NAME: *(REQUIRED)

*E-MAIL ADDRESS: * (REQUIRED)

TELEPHONE:* * (REQUIRED)

CONTACT LENS QUOTE# 2 (MAY BE FOR YOUR CHILD OR RELATIVE)

ENTER YOUR DOCTORS INFORMATION:

MANUFACTURER *(REQUIRED) EXAMPLE: VISTAKON

NAME OF CONTACTS * (REQUIRED) EXAMPLE: ACUVUE ADVANCE

POWER RIGHT * (REQUIRED) EXAMPLE: -6.00

POWER LEFT * (REQUIRED) EXAMPLE: -5.25

BASE CURVE (BC) * (REQUIRED) EXAMPLE: 8.7

DIAMETER * (REQUIRED) EXAMPLE: 14.0

PRICE OF CONTACT FROM YOUR DOCTOR *  (REQUIRED)  EXAMPLE: $155.00 (WOW!)

DOCTOR'S TELEPHONE:* * (REQUIRED)

E-MAIL ME NOW

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