| Send or FAX
the completed form to:
SunTiger Eagle Eyes Pro |
Or Phone
in the order to: Toll Free 1-800-636-9270/ (702) 895-7340 |
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| o/o elton Optical | ||
| 3175 W. Ali Baba Ln. #803 | ||
| Las Vegas, NV 89118 |
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Name: ________________________________________________ Day Phone:_________________ Email:_______________________
Address: ______________________________________________ Evening Phone: ______________
City: ________________________________________ State: ____________ Zip: _______________
Name of Frame: _____________________________________________________
| Lens Material: | CR-39 (Optical | Plastic) |
DriveWear-Transition & Polarized |
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| Lens Type: | Single Vision | Bifocals | Progressives | |
| Lens Color: | Avian 515 |
Eagle PST 475/ 495 | ||
| Coating: | AR |
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Attach a copy of your eyeglass prescription from your eye doctor and use it to fill in the form below.
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| Distance P.D. Pupillary Dist. |
R. Eye (O.D.) |
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| Near P.D.
Pupillary Dist. |
L. Eye (O.S.) |
Note: You must have a P.D. measurement. This is the measurement between your pupils and is needed for proper placement of the lenses in the frame. Sometimes the eye doctor will leave the P.D. off the written prescription. If they have, just call their office for your P.D.
Circle your choice:
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Credit Card No. _______________________________________________ Exp. Date: _______________
Name on Card and Billing Address if different from above: ________________________________________
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