Antarctic Order Form

EMPLOYEE POLAR RX PACKAGES

Include sideshield design frame
Polarized 88-90% glacier density lenses
Gray or brown color options

2016 FRAME AND LENS PACKAGES:
Single Vision……….……..$219 complete
Progressive……………….$299 complete
Non Prescription…………$139 complete
Lens only orders deduct $60 from package price

FEATURED FRAMES…Please note pictures do not accurately reflect lens colors provided.

sherpa
JULBO SHERPA….Average to large fit
works with low to high powers.
Colors…..black only
sherpa
ALTICE PANORAMA….Average fit.
Works with low to moderate powers.
Colors.. black, pewter, purple
ALTICE CHULLO…Average fit.
Works with low to mild powers
Colors… black,pewter, silver
LG Eclipse - Black+Black2
ALTICE ECLIPSE….Smaller fit. Works with
low to very high powers. Colors… black
only
sherpa
ALTICE VENTURE…Reg & Lrg
Narrow to wide fit(2 sizes). Fits
any power. Colors…black, pewter, white
colorado_39114_trans
JULBO COLORADO…Large fit.
Works with low to mild powers.
Colors…black only

PRESCRIPTION POWER GUIDE

LOW…approx +1.25 to -2.00 MILD…approx +1.50 to -2.50 HIGH…approx +2.00 to -4.00
VERY HIGH…anything over the previous numbers (may be subject to additional fee)
TO ORDER: 800-870-5557 303-823-6455…OR FAX 303-823-6457…OR Use the form below…
Calling to discuss your order can make a big difference!

Frame Model

Color (if applicable)

Lens Color (GRAY or BROWN):

Prescription and PD (distance between eyes)   Both are necessary to fabricate lenses

Incorrect prescriptions supplied by customer or doctor will be remade at a 50% discount

O.D. RIGHT

O.D. Right Sphere:
O.D. Right Cylinder:
O.D. Right Axis:
O.D. Right BIF/PROG ADD (if applicable):
O.D. Right P.D.:
O.D. Right Prism (if applicable):

O.S. LEFT

O.S. Left Sphere:
O.S. Left Cylinder:
O.S. Left Axis:
O.S. Left BIF/PROG ADD (if applicable):
O.S. Left P.D.:
O.S. Left Prism (if applicable):

Payment

Visa, MC, Amex, Discover, cashier's checks and money orders accepted

We will contact you to finalize your order. Please provide your information:

Name

Address

Email

Phone

Additional Information

PLEASE NOTE…Other options are available on this site but are not included in the ASC
Polar Package.

Thank you! Denser filters…better fit…you’ll be glad you used us!

*All prices subject to change without notice.