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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


 

Material: Plastic CR-39 - $109.00 Polycarbonate - $134.00
  Polycarbonate 1.0 - $159.00 High Index Plastic - $159.00
         
Extra Options: Bifocal (Flat Top Style) - $35.00
  Anti-Scratch Coating (Plastic CR - 39 only) - $20.00

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:

Brite Ears LLC
P.O. Box 6358
Akron, OH 44312 USA

Phone: (330) 618-8913
Fax: (330) 784-8884

Click here to go back to the order form list

 

 

 

 

 

For more information click Information Request Form and we will be happy to contact you.

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Copyright © 2007 Brite Ears, LLC © 2007 E.A.R., Inc./Insta-Mold West.

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All Rights Reserved.  Last modified: 07/02/2008