Contact Lens Order Form
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    Please provide the following information to insure the correct lenses are ordered:

Name :
Address:
Phone:
City :
Prov.
Birthdate:
Email :

 

Method of Payment :
Visa/Mstrcrd:  Expiry :

 

Will Pick-up C.O.D. Mail

 

Type of Contacts :  Disposable      Clear      Single Vision
 Daily Wear    Tinted      Bifocal

                            

Enter special instructions in space below :

   

 

 

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Copyright © 2003 [Tamarind Optical]. All rights reserved.
Revised: December 22, 2003 .