Print an Order Form

Before you send off your completed order form please ring me (Catherine) on 07767 168 822 – as I may need to ask a couple of questions regarding eye measurements and lens choice.

To Print Your Order Form please click the link below:


If for any reason you have difficulty in downloading or printing out this order form, don’t worry, just contact Catherine by phone 07767 168 822 or email:

[email protected] and we’ll attach the order form for you on an email.

Complete this order form and wrap your glasses carefully and send:

  • Your prescription
  • Your completed order form
  • Your carefully wrapped glasses – please use plenty of bubble wrap (or similar)

Send to:

Reglaze Glasses 4U
26 Greenhey
Lytham St Annes, FY8 4HL​

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