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Ordering and technical information

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719-203-4840

 

Fill in Order Form

Account Number

(1)

Customer Name

(2)

 

(3)

Lens Type    

Ο   Single Vision

Ο   Bi-Focal

Ο   Progressive

(4)

Transitions

Ο  Gray    Ο  Brown

(5)

AR Coating

Ο  AR Coating

 

 

Sphere

Cylinder

Axis

Add Power

 (6)    OD (Right Eye)

 

 

 

(7)

(8)    OS (Left Eye)

 

 

 

(9)

 

 

 

 

 

PD

(10)

Segment Height

(11)

 

Frame Information

Frame Name

(12)

Frame Color

(13)

Follow these 13 easy steps

1.    Fill in your Account Number                                      2.   Fill in Customer Name

3.   Select Lens Type                                                           4.   Select lens Color if applicable

5.   Select AR Coating, if applicable                                 6.   Fill in OD (right eye)

7.   Fill in OD (right eye) Add Power, if applicable.        8.  Fill in OS (left eye)

9.   Fill in OS (left eye) Add Power, if applicable          10.   Fill in PD

11.   Fill in Segment Height if  applicable                     12.   Fill in Frame Name

13.   Fill in Frame Color