Please fill out the form below to order contacts from the Glendale Galleria Store:
(To order contacts from the Valencia store, click here )

Full Name: 

Do you need contacts for right/left or both eyes?   

Do you wear disposable or conventional contact lenses?

If disposable, how many boxes would you like to order?

Would you like to pick them up or have them sent
to your home or work?      

Daytime Telephone Number: 

After submitting this form, we will contact you for your
desired method of payment.