International RX Orders CompanyOrder Date Date Format: MM slash DD slash YYYY Contact DataContact NamePO/REF#Contact Email PhoneSingle Vision RxSphere ODCylinder ODAxis ODDistance PD ODNear PD ODPrism ODBase ODSphere OSCylinder OSAxis OSDistance PD OSNear PD OSPrism OSBase OSProgressivesADDSegment HeightFrameStyleColorLens MaterialPolycarbonateHigh-Index 1.67Lens TypeSingle VisionComputer ProgressivesProgressivesLens TintAmber (BLPF 65)Amber Max (BLPF 98)Clear (BLPF 35)Amber-Transitions ( BLPF 65/90)Clear-Transitions (BLPF 35/90)Sun (BLPF 90)PrescriptionPlease upload a VALID copy of the patient's actual SIGNED prescription. Note that this document must be valid and signed and is required by US law before we can start the order.Upload a FileUpload a FileUpload a FileNotes/CommentsShippingALL ORDERS WILL BE SHIPPED VIA FEDEX INTERNATIONAL PRIORITY <a href="https://www.gunnars.com/form/machform/view.php?id=58" title="International RX Orders">International RX Orders</a>
