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