user
wes
2006-08-02T04:41:37Z
2006-07-09T05:31:57Z
2006-07-09T07:04:40Z
11.5606
6150
7515
360
105
False
False
| 1003-1005 Victoria Road |
| West Ryde NSW 2114 |
Holding Period (For lab only) |
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| Tel: (02)9809 4296 |
1 day 2 days 3 days _days |
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| Fax: (02)9809 3587 |
| Express Eye Care RX Order Form |
Job No.___________ |
| Account Code: |
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Ref: |
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Date: |
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| Lens Type: |
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Rx |
Sphere |
Cylinder |
Axis |
Addition |
Prism |
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Right |
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Left |
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| Frame Type: |
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Right |
Left |
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Coating |
Tints- UV (√) |
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D.PD |
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□ Cut |
□Muticoat |
Col. |
□ Full |
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N.PD |
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□ Uncut |
□Hardcoat |
% |
□ Gradient |
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| Model: |
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Height |
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Fitting instructions: |
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| Color: |
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Width |
Bridge |
Depth |
Diagonal |
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| Size: |
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| Special instructions: |
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| R/S: |
1st L R F |
2nd L R F |
3rd L R F |
_th L R F |
Reason: |
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| Operator: |
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Checker: |
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Sender: |
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Send Date: |
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English:
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9
-3
-3
3
9
9
False
False
False
False
False
False