Prescription Lens Order Form

Please choose one: Duplicate my prescription
New Prescription
No Prescription-Plano Lenses for sunglasses
Please select your Lens type and material

All lenses have free Scratch resistance coating (info)

Single Vision (info)

 Single Vision Plastic [info] $34.95
Single Vision Polycarbonate (info) $59.95
Single Vision1.67 High Index (info) $114.95
Single Vision Transitions (info) $94.95
Single Vision Polarized Sunglass (info) $94.95
Flat Top Bifocal [info] Bifocal Plastic $64.95
Bifocal Polycarbonate $119.95
Bifocal Transitions $124.95
Bifocal Polarized Sunglass $144.95
Flat Top Trifocal [info] Trifocal Plastic $89.95
Trifocal Transitions $139.95
Progressive (no-line) Bifocal [info] Progressive (no-line) Bifocal Plastic $109.95
Progressive Polycarbonate $159.95
Progressive 1.67 High Index $259.95
ProgressiveTransitions $169.95
Progressive Polarized Sunglass $249.95
Mirror Coatings/Anti Reflection Silver Mirror $49.95
Gold Mirror $49.95
Blue Mirror $49.95
Anti-Reflection Coating $49.95
Drill Mountings. Please add for special mountings Drill Mounting $25.00
Lens Packages

Bronze-Free Scratch Resistant Coating $Free
Silver-Ultra Violet Protection (info) & Edge Polish (info) $19.95
Gold-Ultra Violet Protection, Edge Polish, & Anti Reflection (info) $49.95
Lens Tints (info) No Tint
Match ExistingTint $19.95
Add Tint $19.95
Select Color
Amount
Warranty-One year waranty-If your lenses become scratched from normal wear and tear we will replace them at 50% of original price No Warranty
Yes 1 year scratch warranty $19.95
Shipping & Handling Standard $7.95
Express $19.95
Total Your total is: 
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Mail Completed form, your eyeglasses and payment to; Prescription-Lenses.com
Dept L
2411 Third street South
Wisconsin Rapids WI 54494
Contact Information email: info@prescription-lenses.com
phone: 715-423-0201
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