| Please
fill in the spaces completely, otherwise
we will be unable to process your order.
Choose
the lenses you want:
We'll
need the following info to correctly process
your order. You'll find it on your contact
lens prescription that you received from your eyecare
professional.
Please
re-enter the TOTAL number of boxes:
For USA customers please fax your contact lens prescription to 1-877-536-7888.
If you don't have a copy please provide the following information (USA only):
Doctor's
Name:
Doctor's
Phone Number:
Doctor's
Fax Number:
Your DOB (D/M/Y):
Comments?
If placing multiple orders please put
information below.
Have
you ordered before?-
Please
indicate which search engine was used
to find our website-
If
you are referred by a friend, please fill
in their e-mail address or the promo number.
If
you know your customer ID # please enter:
If you would like to place another order:
1. Click "send order", click "back" button
2. Change contact lens information and send
2nd order
3. We will ship both orders together to
save you S & H
X-Contacts is a replacement contact lens company. We can only sell lenses you are currently wearing and prescribed by your eyecare professional. You must have a valid contact lens Rx and be currently wearing the lenses before ordering.
We assume that no eyecare professional has ever advised you that you are not suitable to wear contact lenses, or that you should stop wearing the
prescribed contact lenses. We also assume that customers have not suffered from any eye condition requiring treatment within the last 12 months. Have regular eye examinations
and always follow your eye care professional’s instructions for the proper use and care of your contact lenses. If you have any
eye discomfort, watering, redness, or vision change, remove your contact lenses immediately and consult your eyecare professional.
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