Wear Geo Lens

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All Contact Lens

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† LENS CASING

Info on lens

† Opening of Vial
† Caring for Lens and Lens Case
† Insertion of lens

Order Form

Questions marked with an asterisk * are required to be filled in, or they are not to be taken into account. :)

SPREE #9

*Brand of lens Geo Super Barbie/ Luxury Dueba
*Name:
*Email Address:
*Address:
(Please double check and make sure it is the right address)
*Description:
Include Item Name/ Code, Colour and Quantity
Who referred you?
*Collection Method
Payment method?

Only fill in the following if you have transferred payment!

Amount Transferred ( total + postage )
Reference No. :
Date & Time of Transaction ( e.g. 06Sept2010/16:28 ) :
I-bank Name

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