Please fill out the information listed below and print. Circle all area(s) to be looked at and write down any comments or special instruction if applicable (under comments).  You can either bring this form into our store to help expedite your repair/modification or send it in, to the address listed below, along with your eyewear. Click here to visit our shipping link for help on shipping. Make sure information is accurate.

2443 E. Chapman Ave. Fullerton, CA 92831  -  Tel: (888) 966-9368
 

ALL EYEWEAR SENT MUST HAVE A PRINTED ORDER FORM SENT WITH IT

                 
Name:  

Date:
Email:
Mailing Address:            
Street:   Apt/Suite:
City:  

State:

  

Zip code:
Phone:  

Alt Phone:
Frame Information:              
Model:
 

Color:

  
                 
  Circle Area(s) to be looked at:              
 

                 
Comments: