Lens Order Form

Name :
Email Address :
Contact Number :
Mailing Address :
Order List(with power range) :
Total order (pairs) :
Postage :	Pos Express (1~2Pair RM3) Pos Express (3~5Pair RM4) Pos Express (5~10Pair RM5) Pos Laju (1-7pairs，WM RM7，EM RM9) Pos Laju (8-10pairs，WM RM9，EM RM12) Pos Laju (11-15pairs，WM RM10，EM RM14) Pos Laju (16-25pairs，WM RM15，EM RM18) Pos Laju (26-40pairs RM25 for WM and EM)
Refund account no (in case for out of stock) :