Eye Patch Order Form

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BASIC PATCHESLEATHER PATCHESBLING PATCHESFORMAL PATCHESNOVELTY 1 PATCHESNOVELTY 2 PATCHESNOVELTY 3 PATCHES

FAQ'SS & H QUESTIONSDISCLAIMERABOUT USCUSTOMER TESTIMONIALS

 

 



 
 

 We ship to the United States, Canada, United Kingdom, Australia.

  *Name:                

  *Billing Address :      

  *City/Providence:    *State/Country:    *Zip:      

  *E-mail:                      Phone:  

  

 

 

  Ship to Name:        

  Shipping Address :       

  *City/Providence:    State/Country:  

                        Zip:             

 Click here if this is a gift!  No receipt will be sent with the order and your name will be shown as being sent from.

 

 

 

Design #

Choose Patch

Size

 Choose Patch

Shape

 Choose Patch

 Type

 Choose Trim Color

 Choose Metal Stud Color

 Choose Band

 Length

 Choose Band

Width

Quantity

Amount

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1st Class Mail,

(U.S.A. Customers can also ship) Priority and Overnight

USA $6.00 ~ Canada $8.00

Priority Mail 

$12.00 USA only

Express (Overnight) Mail 

$24.00 USA only

Shipping

    

Grand Total

    

 

 

Card Holder  

                                 Example: John Doe

 

Card # 

                   Example: 1111 2222 3333 4444 

  Exp. Date  /  

Enter your CVV number 
  

(the 3 digit CVV number is  back of card)

 

 

  1.   

     

    Orders Submitted in Oklahoma are subject to sales tax.

We make orders per your request. We do not know if the address, patch size, band length, or any other portion of the order is correct.

The elastic can be adjusted smaller to fit your head, please read the instructions inside your package!

By clicking Submit, you agree to Eye-GrafX return/refund policy.

 
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