RX Quotation Request - LiP Watersports Sunglasses

YOUR CONTACT DETAILS

Name *

First

Last

Email *

Email

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Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Cell Phone # *

PREFERENCES

More options will appear as you progress through the form

Please indicate if you want "frame + lenses" or "lenses only" *

Choose which RX lenses you want *

Which watershades model do you wish to purchase *

Choose your Surge frame colour (please ignore the lenses shown) *

You will choose your lens preferences below

Choose your Typhoon frame colour *

You will choose your lens preferences below

Type of RX lenses required *

Note: for Varifocals, you will need to attend an opticians with a sample frame to obtain an accurate pupil height reading. This is not required for Single Vision lenses.

Do you want the 'Orion-X' anti-fog coating

Yes
No

Note: Our new ORION-X anti-fog extra lens coating works in combination with the double vortex venting system to deliver a lasting and unique solution to lens fogging. Clears lens fogging fast. Recommended for humid climates.

Choose your lens preferences *

Fixed tint lens options *

Smoke (Tv: 15%)
Brown (Tv: 12%)

"Tv" describes the' transmission rate' of the lenses

Photochromic lens options *

Medium / Dark Grey (Tv: 40/12%)
Medium / Dark Brown (Tv: 42/20%)
Medium / Dark Green (Tv: 40/15%)
Medium / Dark Copper (Tv: 40/12%)
Night & Day (Tv: 77/18%)

"Tv" describes the' transmission rate' of the lenses

Polarized lens options *

Smoke (Tv: 15%)
Brown (Tv: 12%)

"Tv" describes the' transmission rate' of the lenses

Polarized and photochromic lens options *

Smoke (Tv: 36/11%)
Brown (Tv: 36/10%)

"Tv" describes the' transmission rate' of the lenses

Do you want a mirror coating?

Yes
No

Choose a mirror coating

Red Mirror
Blue Mirror
Silver Mirror

YOUR RX DETAILS

Please complete this final section after you have completed your contact information and preferences above

Do you have an up-to-date prescription? *

Yes
No
I don't have a prescription

Prescriptions should be less than two years old, and ideally very recent.

To provide an accurate quotation, we need to know your RX readimgs. If you do not have an up-to-date prescription (i.e. less than 2 years old), we would urge you to attend an optician for an eye exam. You may enter an older prescription here for quotation purposes on the proviso that the quotation may be amended later should your prescription readings change.

How would you like to send your prescription

I want to upload my prescription
I would like to enter my prescription

File Upload

Click or drag a file to this area to upload.

Sphere

Right eye

Cylinder

Right eye

Axis

Right eye

Add

Right eye

Sphere

Left eye

Cylinder

Left eye

Axis

Left eye

Add

Left eye

If you have readings for Prism and Base, please enter these readings here. Otherwise, please leave blank.

Prism

Right eye

Base

Right eye

Prism

Left eye

Base

Left eye

How many PD (Pupillary Distance) numbers are on your prescription? *

One
Two

Enter your PD reading here

Enter PD reading for your right eye

Enter PD reading for your left eye

Additional Information

We will reply to the email address you have entered above. During the week we endeavour to reply within 24 hours of receiving your form. If there are any further comments you would like to make, please enter them in the additional info field above and click 'submit'.