Alice and Rabbit's Shop


Local Order Form

Order: Please indicate model and color (ex. Cosplay Lens Ocean Blue) **If using the order form for PROMO use - write both orders in this space ---->lol
Are you ordering "graded/prescription" lens? If you don't require vision correction lens click NO and skip the next question yes
If YES please write down the prescription for each eye in the space provided below. We accept orders for different prescription per eye. (ex L- -2.00 R- -2.50)
Complete Mailing Address (please include your zip code)
Contact Number:
Email Address:
Preferred Payment: ( We will email you the total bill and our payment details after receiving your order) BDO deposit
Union Bank deposit
Western Union
Date of payment:

Form provided by Freedback.