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LENS Order Form



Lens Order Form




Name





Email(If you have FB,kindly give your email used in FB)





Phone no





Office/Home Adress





CONTACT LENS TYPE-QUANTITY



(Eg. DUEBA PRINCESS NUDY BROWN - 1 )


Power:Right/Left



(Eg. 350/325)


Payment method(no akaun akan diemel atau sms)


 CIMB 
 cash deposit 


Payment Period







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