Eyewear Repair Request Form
Submit your eyewear repair job with all necessary details for prompt and accurate service.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Eyewear Type
*
Please Select
Prescription Glasses
Sunglasses
Reading Glasses
Sports Glasses
Safety Glasses
Other
Brand and Model
Which part is damaged?
*
Frame
Lens
Nose Pads
Temple/Arm
Screws/Hinges
Bridge
Other
Describe the damage or issue
*
Specific repair requested
*
Upload photo of damaged eyewear (optional)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Preferred return/delivery method
*
Pick up at store
Ship to my address
Courier service
Other
Submit Repair Request
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