Customer Information

• Call The Frame Mender for a Price Quote
• Print this form and fill it out.
• Please securely wrap your eyeglasses and enclose this form.
• Include all parts (including lenses)
• We recommend you insure your shipment
• We can not be responsible for items lost in transit

Name __________________________________

Address ________________________________

City ___________________________________

State _______________  Zip _______________

Daytime Phone __________________________

Email Address ___________________________

Payment Method

Visa Mastercard Money Order
Cashier's Check (NO Personal Checks)

Card No. _______________________________

Exp. _________________

Name on Card ___________________________

Signature _______________________________

Please indicate points of breakage

The Frame Mender Guarantees All Work
For As Long As You Own Your Glasses

If our repair should fail within that time, return it to us and we will repair your frame again at no charge to you.

DISCLAIMER

The Frame Mender is confident about the
repair of your frame; however:

We can not be responsible for the condition
of your lenses (former scratches, etc.)

The trim color on metal frames can be lost or
discolor during the repair process.

Customer will not hold Frame Mender responsible.

I understand and agree.

________________________________________
(Sign Here)

Mail this form to: The Frame Mender
1010 Rockville Pike
Suite 100
Rockville, MD 20852
301-340-7100