ART-LENS: Contact Lenses Orders

Orders:

L.C. ART-LENS Order

Trade Name:


Address:		Postal Code:


Location:		Telephone Number:


E-mail:		N.I.F.


Contact Person:


PARAMETERS:

Lens Type:	Lens power:	Lens radius:

Pupil diameter:	Iris diameter:	Total lens diameter:


Definitive lens:	Test lens:

COLOUR:

Lenses with base colours:	Iris colour reference #:	Crown colour reference #:


Pathology to treat:
Description:


Customized lenses:
Description for customized colour option (ask):


Attach an image:
Attach an image:
Attach an image:
(Please, send images in GIF or JPG format and smaller than 1Mb)

Art-Lens is committed to respect privacy of all data according to the Organic Law 15/1999.

ART-LENS - Passeig de Gràcia 117, pral. 1ª - 08008 BARCELONA - Telf: 93 217 31 68 - Fax: 93 415 91 75 - Contact