Your billing address is the address your credit card statement is mailed to and must match the billing address you enter exactly. If you have moved recently please use your old address if you have not updated it. A debit card's billing address is usually the address your bank statement is mailed to however it may be the original address on the account if you have changed the mailing address. Orders with billing addresses or security codes that do not match cannot ship. We do not accept credit cards with a billing address outside the U.S. and U.S. territories. All prescriptions must be verified, you may fax a copy to (206) 222-2257 or scan and email to info@contactlens.com If you do not have a copy you must include your doctor or store's phone number or enough detailed information to find the exact phone number (please help: "Sears, Dallas" isn't enough). Incorrect or missing information will delay your order. We do not send spam email, we do confirm your order by email. If you do not receive a confirmation please check your account's email address is correct. Already registered? Please Click here to login.

All required fields are bold

Billing Information     First Name :   Last Name :   Company or In Care Of Name :   Address Line 1 (30 Figure Max) :   Suite, Apt, Floor Number :   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 (5 Number Only) :   Country : United States American Samoa Guam Puerto Rico St. John St. Thomas United States Minor Outlying Islands Virgin Islands (U.S.)   Phone Number (20 No. Max) :

Shipping Address     Shipping address is the same as billing   Please check this box if your shipping information is the same as billing.     Name (20 Characters Max) :   Company or In Care Of Name :   Address Line 1 (30 Figure Max) :   Suite, Apt, Floor No. :   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 Guam 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 :   Would you like to receive? : Product Updates Our Newsletter   E-mail format : HTML Messages Text Messages   How Did You Find Our Site : Please Choose One Google Text Google Top or Side Ad Yahoo Bing www.Contactlens.com Referral Other Kaplah Price Grabber NexTag

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 Birthdate or Patient 2 Name: (You may enter "none" for birthdate if you wish)   Patient 2 Doctor or Store Name:   Patient 2 Doctor or Store City/State/Phone:   Patient 2 Contact Lens Name: (Example: Biofinity, Oasys. If both same enter powers)

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

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