Repair Form Name* First Last Glasses Description (Brand, Color, Model Number if known)*Shipping Address*The address you want your glasses shipped to when repaired. Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email Address*PhoneRepair Type*Select OneHinge Repair | Arm Reattach: $78.95Flexon Frame Repair $99.95Nose Bridge Repair (Metal bridges only, not plastic): $78.95Reattach Nose Pad Arm: $68.95Restring Half Wire Frame: $39.95Replace Both Temple Arms-Silhouette frames ONLY (non OEM) $129.95. Non-OEM means not Original Equipment Manufactured. They work like the originals and are made of partial titanium.Replace Both Temple Arms: $78.95.Please select the appropriate repair type to be performedReturn Shipping MethodSelect OneFirst Class Mail - FreeUSPS Priority Mail - $10.95USPS Priority Mail Express - $39.95How fast do you want your glasses returned to you?Total $0.00 Payment Method*Select OnePayPalCredit CardCredit Card Payment American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20242025202620272028202920302031203220332034203520362037203820392040204120422043 Expiration Date Security Code Cardholder Name PhoneThis field is for validation purposes and should be left unchanged. Δ
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