Order Form

Dear customers, please completely fill out the order form below:

*Order will be processed and an invoice will be sent to you after receival of order form.

Name:
Phone No:
Shipping Address:
Neo Color Lens:	- Please Select - Neo Sunflower Edge Aqua Neo Sunflower Edge Blue Neo Sunflower Edge Brown Neo Sunflower Edge Gray Neo Sunflower Edge Green Neo Sunflower Edge Hazel Neo Sunflower Edge Honey Neo Sunflower Edge Violet Neo Color Circle Blue Neo Color Circle Brown Neo Color Circle Green Neo Color Circle Gray Neo Color Circle Violet Neo Black Circle/ Cuty Black Neo Chagall Circle/ Cuty Charm Neo Ring Circle/ Cuty Circle Neo Carra Circle/ Crystal Black Neo Dali Circle/ Sweet Chocolate
Left Eye PWR:	0.00 -0.25 -0.50 -0.75 -1.00 -1.25 -1.50 -1.75 -2.00 -2.25 -2.50 -2.75 -3.00 -3.25 -3.50 -3.75 -4.00 -4.25 -4.50 -4.75 -5.00 -5.25 -5.50 -5.75 -6.00 -6.50 -7.00 -7.50 -8.00 -8.50 -9.00 -9.50 -10.00
Right Eye PWR:	0.00 -0.25 -0.50 -0.75 -1.00 -1.25 -1.50 -1.75 -2.00 -2.25 -2.50 -2.75 -3.00 -3.25 -3.50 -3.75 -4.00 -4.25 -4.50 -4.75 -5.00 -5.25 -5.50 -5.75 -6.00 -6.50 -7.00 -7.50 -8.00 -8.50 -9.00 -9.50 -10.00
Geo Color Lens:	- Please Select - Geo Wing Violet Geo Wing Blue Geo Ash Wing Geo Honey Wing Geo Angel Blue Geo Angel Brown Geo Angel Gray Geo Angel Green Geo Angel Violet Geo Fresh Brown Geo Fresh Gray Geo Magic Two Tone Blue Geo Magic Two Tone Brown Geo Magic Two Tone Gray Geo Magic Two Tone Green Geo Magic Two Tone Violet Geo Nudy Blue Geo Nudy Brown Geo Nudy Gray Geo Nudy Green Geo Nudy Golden Blue Geo Nudy Violet Geo Tricolor Blue Geo Tricolor Brown Geo Tricolor Gray Geo Tricolor Green Geo Tricolor Violet Geo Twins YH-301 Geo Twins YH-302 Geo Twins YH-303 Geo Twins YH-304 Geo Twins YH-305 Geo Twins YH-306 Magic Circle Black IM-108 Magic Circle Black CK 101 Magic Circle Black CK 105 Magic Circle Black CK 107 Magic Circle Black CM 836/Angel Black Magic Circle Black Angel 101/Angel Define Magic Circle JB 101/Jazz Brown Magic Circle JB 102 Conventional Soft Lens Lux Pro Conventional Soft Lens RX-3 Conventional Soft Lens RX-View Animation Lens CP-A1 Animation Lens CP-A2 Animation Lens CP-A3 Animation Lens CP-A4 Animation Lens CP-A5 Animation Lens CP-A6 Animation Lens CP-A7 Animation Lens CP-S1 Animation Lens CP-S3 Animation Lens CP-K4 Animation Lens CP-F1 Animation Lens CP-F2 Animation Lens CP-F3 Animation Lens CP-F4 Animation Lens CP-F5 Piercing IM-703 Piercing IM-705 Piercing IM-707 T-eye 731 T-eye 732 T-eye Melon Tear Brown Tear Gray
Left Eye PWR:	0.00 -0.25 -0.50 -0.75 -1.00 -1.25 -1.50 -1.75 -2.00 -2.25 -2.50 -2.75 -3.00 -3.25 -3.50 -3.75 -4.00 -4.25 -4.50 -4.75 -5.00 -5.25 -5.50 -5.75 -6.00 -6.50 -7.00 -7.50 -8.00 -8.50 -9.00 -9.50 -10.00
Right Eye PWR:	0.00 -0.25 -0.50 -0.75 -1.00 -1.25 -1.50 -1.75 -2.00 -2.25 -2.50 -2.75 -3.00 -3.25 -3.50 -3.75 -4.00 -4.25 -4.50 -4.75 -5.00 -5.25 -5.50 -5.75 -6.00 -6.50 -7.00 -7.50 -8.00 -8.50 -9.00 -9.50 -10.00
For more than one item,  please fill in your order here:   (e.g. CK-105  -1.00/-1.00 x 1)

Total Quantity Pair(s):
Email Address:
Method of Payment:	MayBank2U (Online Transaction) Bank-in (Maybank) Bank-in (Public Bank) Cash on delivery PayPal Others
Disclaimer This disclaimer of liability applies to any discomfort or injury caused by contact lens wear. IMPORTANT: Seek advice from eye-care practitioner to verify proper fit and follow the proper lens care guideline. Follow the suggested wearing schedule which is not more than 6 hours per day to maintain your overall eye health. I have read and understand the above statement and I accept full responsibility for my ongoing eye care and for the suitability of the contact lenses purchases.

For any inquiry, please contact us at: char_lens@live.com