Place RX Order — lens outlet usa

Mon–Fri · 11 AM–6 PM EST · sales@lensoutlet.com · 347-930-1320

Place RX Order Order Stock Cart 0

📞 347-930-1320 Place Order

Job Information

Job Reference #

PO Number

Tray #

Patient Name

Patient ID / DOB

Date Needed

Account

Account #

Contact First Name

Contact Last Name

Lens Selection

Material *

AR Coating *

Upgrades *

Transitions *

Tint Selection

Tint *

Secondary Tint

Tint Color

Lens Use *

Distance Reading Computer Sunglass Progressive and Bifocal Sports

Prescription (Rx)

	Sphere	Cylinder	Axis	Add	Mono PD (Far)	Mono PD (Near)	Seg Ht
R
L

Type each value (e.g. -2.25, -0.75, 90, +2.00, 31.5). Leave blank if not applicable.

Prism (Optional)

	Amount	In / Out	Amount	Up / Down
R
L

Frame

Frame Type

Frame Brand / Model

DBL

Vertex (mm)

FaceForm / Wrap (°)

Panto (°)

Lab Specifications (Optional)

Base Curve

Center Thickness (min)

Decentration (in/out)

Slab Off

Polish Edges

Lens Drill Pattern

Tracing / Pattern File

Optional. Native checkout can't attach files — if you add one, we record its name and you email it to sales@lensoutlet.com with your Job Ref.

Optional Services Add Edging Service (+$20.98 per pair) Plastic, metal, or logo (groove) frames only — not drill-mount

Shipping Method

Standard (5–7 business days) — included Rush Service (2–3 business days) — call for quote Will Call / Customer Pickup

Special Instructions

Surface (RX) Lab Order