Please print out this form, attach your tracing and send by mail, along with the Billing Information.
Circle Lens Type: Overhead Computer Temporary BiFocals
Circle Enhancer Type: Attachable Complete Frame
Circle Lens Strength Row Number: 1 2 3 4 5 6 7 8 9
To help serve you better please give a brief description of what enhancers will be used for:
Please give as much information as available on your eyewear:
1. Lens Type (Circle or Describe):
Single Vision Lined BiFocal Lined TriFocal
Round BiFocal Progressive or No Line BiFocal
Not Wearing Lenses
Other:
2. Frame Manufacturer:
3. Model Number or Name:
4. Frame Size (ex. 52 18):
Not recommended for excessive thick lenses or rimless frames. For the best fit and size of your enhancers please trace your frame in the space provided below the example. Place your frame face down on paper with your lenses against a clean soft piece of cloth so as not to scratch your lenses and trace closely around the frame. Please send this form and tracing by Mail along with billing information.
Example:
Trace your frame here:
Enhancers have been tested and proven to be frame and lens friendly with normal wear and everyday use. Not responsible for any damage that may occur to your existing eye wear. Enhancers are not safety frames or lenses and are not OSHA approved.
