Email the following info To luxuryshadez@gmail.com
Please copy and paste form to make it easier for production
Single Vision- Near, Intermediate or Distance
SPH CYL AXIS ADD
OD (Right)
OS (LEFT)
(PD) Pupillary Distance if two PDs ☐
Progressive- Near, Intermediate, and distance in one lens
SPH CYL AXIS PRISM
OD (Right)
OS (LEFT)
(PD) Pupillary Distance if two PDs ☐
Reading Glasses- One magnification field for Reading
-Readers- Select a magnification Strength
(Example +0.25, +0.50, +0.75 and Up to +6.00)
List a magnification Strength Here
Type of Prescription
Single Vision
Progressive
Readers- Strength
Lense Type
Lens index
The higher index you choose, the thinner the lenses will be
☐ 1.57 Mid- Index $10.00 ☐ 1.61 High-Index – RECOMMENDED $25.00
☐1.67 High Index $55.00 ☐1.74 High Index $150.00
Coating
☐ Standard Coatings- Reduces light reflections $10.00
☐Advanced Coating (Recommended) Water-resistant, easy to clean reduces light reflections $15.00
☐Ultimate Coatings $20.00
☐No Coating –FREE
To start production all items must be
PAID IN FULL
