On-line Contact Lens Ordering

PLEASE NOTE:

THIS SERVICE IS FOR CUSTOMERS OF FIRST OPTIC ONLY

IF YOU REQUEST HOME DELIVERY OR A QUOTE THEN ONE OF OUR STAFF SHALL TELEPHONE YOU USUALLY THE NEXT WORKING DAY FOR CREDIT/DEBIT CARD PAYMENT.

WE ACCEPT

Please provide the following contact information:

Title

Surname First Name
Street Address
Address(cont.)
City/Town
Postal Code
VERY IMPORTANT Day Time Contact Number (Mobile?) email address

Please provide the following product information:

I wear daily disposable lenses Go to section A below (ignore B)

I wear permanent soft lenses Go to section B below (ignore A)

I wear gas permeable lensesGo to section B below (ignore A)

Section A

I wear

and would like

boxes for the right eye

and

boxes for the left eye.

COST

Sauflon New Day £14 per box

Ciba Dailies......£14 per box

( or £80 for 6 boxes)

Ciba Dailies Toric and Progressive...£18 per box

Acuvue 1 Day........£22.50 per box

( or £102 for 6 boxes)

Daysoft UV.........£12 per box

Section B

I would like to order

lens

I would like to be given a quote before you order

Do you require home delivery (free of charge)? Yes No

	SHIPPING (IF DIFFERENT FROM ABOVE)
Street Address
Address (cont.)
City/Town
County
Postal Code

Additional Comments:

PLEASE WAIT FOR THE CONFIRMATION PAGE TO ENSURE IT HAS BEEN SENT