Order Contacts

Order Contacts

Order Contacts

Order Contacts

Order Contacts

Order Contacts

Order Contacts

Please fill out the information below, and we will contact you to confirm your order, give you final pricing, and rebate information if applicable.
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Name (required)

Email (required)

Phone Number (required)

Select an Office (required)

Are you a patient of our office?

If you are not a patient of our office, please upload a current prescription.

Supply Option

Using Insurance

Please provide the name of your vision insurance.

Are you the primary on the insurance and if not, please provide the information of the primary.

Preferred Method of Contact

Which method of payment were you planning to use for this order?

How would you like us to contact you for payment?

Which address would you like these contacts shipped to? (required)

Additional Comments

MawzPawz254@ none 230 W. Superior St. Suite 100N,
Chicago, IL 60654 14215 LaGrange Road
Orland Park, IL 60462 3126260036 7083499327 3122551367 7083499473 chicago@weareyewear.com orland@weareyewear.com 9:00am - 5:00pm 10:00am - 5:00pm 9:00am - 6:00pm 10:00am - 5:00pm 9:00am - 5:00pm Closed Closed 10:00am - 5:00pm 10:00am - 5:00pm 10:00am - 5:00pm 10:00am - 5:00pm 10:00am - 5:00pm 9:00am - 3:00pm Closed https://www.facebook.com/WearEyeWearChicago/ https://www.facebook.com/WearEyeWearOrlandPark