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We do not take payment on-line.  Instead, we ask you to complete this form, print it out and send it to us with your cheque.  We will then ship your lenses to you by return of post.  Please tick the lenses you would like to order:

Johnson & Johnson Acuvue
1 year's supply:     360 pairs @ £1.15 per pair + p&p £3 = £417.00
6 months' supply:  180 pairs @ £1.15 per pair + p&p £3 = £210.00
3 months' supply:    90 pairs @ £1.15 per pair + p&p £3 = £106.50

Your prescription (select from the drop-down boxes):

Left eye - distance

Right eye - distance

Left eye - base curve

Right eye - base curve


Focus Dailies
1 year's supply:     360 pairs @ £1 per pair + p&p £3 = £363
6 months' supply:  180 pairs @ £1 per pair + p&p £3 = £183
3 months' supply:    90 pairs @ £1 per pair + p&p £3 = £93

Your prescription (select from the drop-down boxes):

Left eye - distance

Right eye - distance

Left eye - base curve

Right eye - base curve


(If you only require lenses for one eye, enter the same prescription details in both boxes.  In such a case, of course, a three-month supply will last you for six months or a 6-month supply for a year.)

Total cost:  £ (Enter figure from the relevant line above)

Your Details

Title:

Address:

Forename:

Surname:

* Daytime telephone:

* e-mail address:

Fields marked * are requested in case we have to contact you to clarify your order

We collect your personal details only in order to supply you with the lenses you order.  We will not share your details with any third parties, or send you any unsolicited e-mail offers.  Please make your cheque payable to "K. Chapple", enter your cheque card details on the back of it, and send it with this form to: K. Chapple Optometrist, 52 Cliffe High Street, Lewes, East Sussex BN7 2AN.

 

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