Contact Lens Re-order Form Name* First Last Email* Date* Month Day Year Address* Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Phone*Quantity:* Six month supply One year supply Pick Up / Shipping* Pick up at office. Shipped Direct from Manufacturer. (extra fee may apply) Δ
