Please fill out this form if you are interested in joining this pre-order.
and kindly send all orders to email: miya_lens@hotmail.com

Types of order (Pre-order or Ready-stock?) :
Name :
Email :
Contact No. :
Address :
Contact Lens Models/Code & Power degree ( Left/Right. If any ) :
Quantity ( Pair ) :
Message ( if any ) :

Example:
Types of order : Pre-order
Name : Mia
Email : miya_lens@hotmail.com
Contact No. : 014-6249038
Address : No.xx, Jln xx, Tmn xx, 58000 KL, WP, Malaysia
Contact Lens Models/Code & Power degree ( Left/Right. If any ) : CH-625 (100/200)
Contact Lens Models/Code & Power degree ( Left/Right. If any ) : CM-834 (0/0)
Quantity ( Pair ) : 2 pairs contact lens + 2 pcs lens case
Message ( if any ) : Lens case x 2 pcs