Brite Ears LLC Specialized Hearing Systems:
Sportsman Glasses Order Form
Client Information
Client Name
Ship to:
Name
Address
City/State/Zip
Country
Contact
Phone
Product Information:
Carbon Pro Packages
Single - $65.00
One Lens Frame Color:
Tortoise
Translucent
Black
Standard - $90.00
Medium Amber, Hunter Orange and Lt. Vermilion Polycarbonate Lenses, 3
nose pieces, case Frame Color:
Tortoise
Translucent
Black
Selective - $90.00
Price dependent on selection of 2 additional lens colors, 3 nose
pieces, 1 case Frame Color:
Tortoise
Translucent
Black
Non-Polarized Lenses - $22.00ea
Optic Yellow
Light Vermillion
Light Purple
Dark Gray
Hunter Orange
Dark Amber
Amber Brown
Green
Clear
Cobalt Blue
Medium Gray
Light Amber Rose
Polarized Lenses - $40.00ea
Polarized Amber
Polarized Gray
Carbon/Blue Steel Packages
Single - $60.00
One Polycarbonate Lens Frame Color:
Carbon
Blue Steel
Camouflage
Standard Package - $90.00
Medium Amber, Hunter Orange and Light Vermillion Polycarbonate Lenses, 3
nose pieces, 1 case Frame Color:
Carbon
Blue Steel
Camouflage
Selective Package - $90.00
Prices dependent on selection of 2 additional lenses, 3 nose
pieces, 1 case Frame Color:
Carbon
Blue Steel
Camouflage
Non-Polarized Lenses - $22.00ea
Optic Yellow
Light Vermillion
Light Purple
Amber
Dark Gray
Hunter Orange
Vermillion
Medium Purple
Medium Gray
Dark Green
Clear
Dark Vermillion
Dark Purple
Green
Dark Gray Mirrored Lens
Light Amber Rose
Dark Amber
Cobalt Blue
Polarized Lenses - $40.00ea
Polarized Amber
Polarized Gray
Extra Frame - $25.00
Carbon
Blue Steel
Camouflage
Classic Competition Packages
Single
Package - $75.00
One lens Frame Color: Silver
Tortoise
Translucent
Black
Standard Package - $110.00
Medium Amber, Hunter Orange, Vermilion Polycarbonate Lenses, 1 case Frame Color:
Tortoise
Translucent
Black
Silver
Selective
Package - $110.00
Prices dependent on selection of 2 additional lenses, 3 nose
pieces, 1 case Frame Color:
Tortoise
Translucent
Black
Silver
Non-Polarized Lenses - $25.00ea
Optic Yellow
Hunter Orange
Medium Grey
Dark Grey
Light Amber
Medium Amber
Dark Amber
Vermillion
Medium Purple
Green
Clear
Cobalt Blue
Polarized Lenses - $60.00/pair
Polarized
Amber Polarized
Grey
NYX Arrow Glasses
Standard Package - $110.00
Medium Amber, Hunter Orange, Vermilion Polycarbonate Lenses, 1 Foam
Lined 4-Slot Carrying Case,
1 Soft Micro-Fiber Poly Bag Carrying
Case
Fisherman Package - $145.00
Polarized Grey Medium Amber, Hunter
Orange, Vermilion Polycarbonate Lenses,
1 Foam Lined 4-Slot Carrying Case,1 Soft
Micro-Fiber Poly Bag Carrying Case
Golfing Package - $110.00
Optic Yellow,
Medium Gray, Dark Gray Polycarbonate Lenses, 1 Foam Lined 4-Slot
Carrying Case,
1 Soft Micro-Fiber Poly Bag Carrying
Case
NYX Photochromic Comet Glasses
Standard Package - $100.00
The Comet comes with durable storage case, micro fiber poly-bag cleaning
cloth,
1 set of photochromic lenses and frame.
NYX Talon
Glasses
Standard Package - $120.00
Package includes one set of glasses,
poly-cleaning cloth and single carrying case.
Frame Color:
Black
Tortoise
Green/Purple Chameleon
NYX Ultra-Lite
Glasses
Standard Package - $109.00
Package includes storage case,
poly-cleaning cloth and NYX Ultra Lite sunglass.
Extra Frame - $25.00
Tortoise
Translucent Black
Silver
Extra Case - $22.00
Black
Camouflage
Extra Micro-Fiber Polybag Carrying/Cleaning Case - $10.00
Number of Bags
Extra Nose Pieces - $3.00
Number of Pieces
NYX Lens Cleaner Spray Bottles - $8.00
Number of Bottles
Prescription Information
These are the materials which can be used to manufacture your intraSPX™
inserts
Eye Exam Measurements
Please insert your current eye exam measurements below. Include + or -
signs where appropriate within measurements text. Inserts will ship
separately unless specified to ship with order. Usual lead-time is 1-2
weeks.
Right:
Spherical
Left:
Spherical
Cylindrical
Cylindrical
Axis
Axis
Bifocals:
Near
Near
Pupilary Distance (PD):
mm
Special Instructions
If you have any special instructions, please
explain in the space provided:
Payment Method
Personal Check
Company Check
Visa
MasterCard
Account Name
Account Number
Exp. Date /
All orders will be sent UPS Ground unless specified above. Foreign
countries, please contact us before ordering.
To submit an order, fill out this form,
print it, and then either fax it, or mail it to:
