Need your eye glasses fixed, but can't find the time to stop by a repair shop? Or maybe you don't have a eye glass repair shop close by? Well, look no further for your eyeglass repair solution! You mail us your broken glasses with the form below, and we'll mail them back to you as-good-as-new!

Make sure you print this entire page!

Mail Order Form - Manassas Eyeglass Repair


First Name: ________________________      Last Name: __________________________

Address: ___________________________________________________________

City: ______________________    State: ______________       ZIP: ______________

Phone Number: (________)-_________-__________

Notes for our technicians:

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

We currently offer one convienent way to pay!

CREDIT CARD (enter info below)

Card type: _________________  Name on card: __________________________________

Card #: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _       CVC # (three digit code on the back of most cards): _______

Card expiration/valid thru date: ___/___ Billing Zip Code: ________ Amount authorized: $______

*You will be charged only $37.95 for your repair, if any added charges are necessary our technicians will contact you.
Standard shipping is FREE, but if you would like Priority shipping, please add $5.20




Shipping Label (Cut and tape/glue to the front of your package)