Call us now and we will let you know if we work with your insurance. Our experienced and knowledgeable staff will help you get maximum benefits from your insurance plan. From Medicare to AARP, we work with various insurance companies to make things easier for you. Get in touch with SAME Day Glasses & Contacts today.
SAME DAY GLASSES & CONTACTS 7419 256th AVE SALEM, WI 53168 262-843-3081 Credit Card Recurring Payment Authorization Form For SAME Day Glasses & Contacts Vision Insurance *Offer valid on store credit only, no refunds for accumulated charges Schedule your payments to be automatically charged to your credit card. Just complete and sign this form to get started! Recurring Payments Will Make Your Life Easier: • It's convenient (saving you time and postage) • Your payment is always on time (even if you're out of town), eliminating late charges • You can get Rewards Points for paying your bill Here's How Recurring Payments Work: You authorize regularly scheduled charges to your Visa, MasterCard, American Express or Discover card. You will be charged the amount indicate below each billing period. A receipt will be emailed to you and each charge will appear on your statement. You agree that no prior-notification will be provided unless the date or amount changes, in which case you will receive notice from us at least 10 days prior to the payment being collected. Please complete the information below: I _____________________________ authorize SAME DAY GLASSES & CONTACTS to charge my credit card (full name) indicated below for $20.00 on the 1st DAY of each MONTH for payment of my EYE GLASSES/CONTACTS. At the end of each year you will have accumulated 240$ which qualifies you to Spend up to $500. Total savings of $260 per year for spending ONLY $20 dollars per month!! Billing Address ___________________________ 262-843-3081_______7419 256TH AVE SALEM,WI 53168 ____________________________ Email ____________________________