USA Sport Eyewear       PRESCRIPTION ORDER FORM

Please attach your prescription to this form and fax or mail it to us.  Delivery is generally 7-10 business days, plus 5 for coating, although special Rx’s could take a little longer.  Super rush orders have an extra charge of $35. No refund or cancellation allowed after payment. Any problem glasses can be credited to re-done prescription.

 

Prescriptions will be filled in antishatter polycarbonate except insert glasses (outer glasses are already polycarbonate) which must be in optical plastic to avoid distortion.  Upon request, we are able to supply your prescription in Z87 industrial safety thickness – at no extra charge.

 

PRESCRIPTION MUST INCLUDE PD (PUPILLARY DISTANCE).  If PD is not on your prescription, simply contact whoever gave you glasses at any time and ask for your PD.

 

Single vision prescriptions are priced as follows and include Rx sunglasses in custom cases:

 

ALL MODELS:       Clear     Tint     Polarized     Photochromic (Day & Night)

                   $99      $149        $229           $229

 

        EXTRA TREATMENT (To add to above prices), CIRCLE ITEMS WANTED     

Progressive (NO-LINE)           $125   ALIZE Anti-Reflect, Anti-Scratch    $79 

Flattop Bi-focal (D28 Segment)  $50      Anti-Sweat, Hydrophobic Coating

TD-2 Anti-Scratch Coating       $39    Transitions SUPERDARK Tinting       $35

Mirror Coating                  $59    Surcharge for Sun Pro Models        $25

  (Silver, Gold, Blue, Red)            Surcharge for Powers Above 3.50     $35

Anti-Reflective Coating         $40    High Index for Very High Powers     $50

  (Ideal for Night, Dusk, and            (Super Thin)

   High Glare Conditions)              Rimless Models                      $50  

2 PAIR – DIFFERENT Rx–10% OFF EACH. SAME Rx WITH COATINGS - 50% OFF 2ND PAIR.

 

SHIPPING: UPS Ground:$9.50  UPS 2nd Day Air:$17.50  UPS Next Day Air:$35.00___   

 

Name: ________________________________    USA Sport Eyewear      

                                          6780 Miramar Rd #106              

Address: _____________________________    San Diego,CA 92121                 

                                          Phone: (858)635-3155

______________________________________    Toll Free: (800)284-0434

                                          Fax: (858)635-3160

Phone: ____________ Cell: ____________    E-Mail:usasportsd@aol.com

                                          Web Site:www.usa-sport.com

Fax: _________________________________

 

E-Mail: ______________________________

 

                       ORDER DETAILS                             

    Sunglass        Frame         Lens        Extra

      Model         Color         Color     Treatment                 Amount

________________________________________________________             ________

________________________________________________________             ________

                                                           Shipping  ________

             California Residents add 7.75% Sales Tax      Tax       ________

                                                           Total     ________

Check ___  Money Order ___

Mastercard ___   Visa ___   Discover ___   American Express ___

Number ________________________________ Exp. Date _____________