Order Form | DSW Optical

Company/ref:details*
(*please give any reference you require to be given if we need to contact you)
Address*
(*postal address to be used)
Contact details*
(*phone number or e-mail contact in case of query)
Required due date*
(*your preferred due date. If no specific date please choose ASAP)
Lens type*
Bifocal type*
(*please choose Type eg Round/D/C/ Exec etc. and size eg R24/D28 etc)
Please choose Standard or Branded name*
(*If Standard is chosen we will provide a generic lens best suited to your needs based on frame/lens choices. For Branded lenses please specify full name including corridor version where applicable)
Brand Name*
(*Including corridor version where applicable)
Please choose working distance/degression or N/A*
(*choose N/A Only if a branded lens with corridor version has been specified, for working distance we require distance in m or mm)
Distance*
(*please specify if m or mm)
Please specify use for lenses*
(*eg Enhanced driving/Golf/Boosted reading etc.)
Please choose Standard or Branded name*
( *If Standard is chosen we will provide a generic lens best suited to your needs based on frame/lens choices. For Branded lenses please specify full name)
Lens Brand Name*
Please choose Standard or Branded*
(*for branded lenses please provide full name)
Lens Brand Name*
Please choose Standard Basic/Enhanced/Best*
(*Standard are good entry level general use lenses, Enhanced have increased width of distance and reading areas for a more comfortable wear/Best are individualised based on frame shape and prescription to offer enhanced fields of vision and clarity)
Please choose Long/Regular/Short/Lab chooses corridor length*
(*Most Varifocals come with different corridor lengths, normally this is because on a deeper frame you can have more space for the intermediate zone or on a narrower frame you can reduce the intermediate to ensure getting a full reading prescription, some people also prefer a type based on their previous history of glasses wearing or lifestyle. If you don't know which would suite best we will choose for you based on prescription and frame details)
Please specify exactly which lens you require*
(*if you are not certain which lens to choose or what it is called please contact us for advice)

Right Eye Details
Right Sphere Power*
(*Prescription for Right Sphere, must specify + or - /if no power please choose PLANO)
Right Cyl Power*
(*Prescription for Right Cyl, must specify + or - /if no cyl, please enter "0" if NONE)
Right Axis*
(*Axis for the Right lens, must be between 0 and 180 degrees/if no cyl then please choose NONE)
Right Add*
(Right Add / if no Add required please choose NONE)
Right Prism*
(Right prism, must specify direction up/down/in or out. If no prism please choose NONE)
Right optical centre*
(*This is often referred to as pupil distance 'PD' or distance/reading centre – if not known please call us for assistance. Please only give the PD you want us to use)
Right Height*
(*This is often called fitting heights and is measured from pupil or lower lid down to the box centre of the frame/if no heights. This can also be given in relation to frame centre if specified as such. If no Heights required please choose NONE)

Left Eye Details
Left Sphere Power*
(*Prescription for Left Sphere, must specify + or - /if no power please choose PLANO)
Left Cyl Power*
(*Prescription for Left Cyl, must specify + or - /if no cyl, please enter "0" if NONE)
Left Axis*
(*Axis for the Left lens, must be between 0 and 180 degrees/if no cyl then please choose NONE)
Left Add*
(Left Add / if no Add required please choose NONE)
Left Prism*
(Left prism, must specify direction up/down/in or out. If no prism please choose NONE)
Left optical centre*
(*This is often referred to as pupil distance 'PD' or distance/reading centre – if not known please call us for assistance. Please only give the PD you want us to use)
Left Height*
(*This is often called fitting heights and is measured from pupil or lower lid down to the box centre of the frame/if no heights. This can also be given in relation to frame centre if specified as such. If no Heights required please choose NONE)

Index of lens*
(*please choose 1.5 as standard. Available in up to 1.76 in plastic and 1.9 in Glass)
Aspheric/Non-Aspheric*
(*please choose Non-Aspheric as standard. Please note that 1.67 index and above will come as Aspheric as standard in plastic)
Coatings – Please choose None/Hard coat/Anti reflection coat/MAR+/Other*
(*If non required please choose NONE and we will provide the minimum level of coating which comes as standard)
Other*

Tints/Photocromic/None*
(*Photocromics change depending on light levels, tinted lenses have a permanent depth and colour at all times)
Tint Full or Graduated*
(*full tints cover the whole lens, graduated fade as they go down the lens)
Colour of the tint*
(*if choosing one colour just specify, if choosing rainbow tint please be specific on which one is at the top)
Depth of tint*
(*normally in % Must specify LTF or ABS, if you just want 'light' or 'dark' we will choose % for you. If tint is Graduated please give darkest and lightest amounts wanted)
Photocromic/Transition*
(*Please specify colour and make eg.Xtractive,Sensity etc.)

Frame to follow/Frame to be supplied*
(*are we preparing lenses for you to send to us later or would you like us to supply the frame also)
Full frame/Supra/Inline Supra/Rimless/Other*
Frame size A measurement in mm*
(*normally written on the side of the frame or the centre of the bridge, if not please measure across the frame)
Frame size B*
(*measure from top to bottom across the centre of the frame in mm)
Frame DBL in mm*
(*normally written on the side of the frame or the bridge, if not please measure across the centre of the bridge from the Right lens to the Left lens)
Upload a photo of your frame
Accepted file types: jpg, png, gif.
Frame name*
(*for example Planet 08 or Ecoline 3)
Colour of frame*
(*please choose either the colour or the colour number eg Gold or Col.3)
Frame Eye Size*
(*please ensure you give both the eye size and DBL eg 50/19)
Frame Arm*

Other instructions*
(*please advise us of any other information eg. Polish edges, add depth, advise when ready etc.) or none if there is no other instructions
Name
This field is for validation purposes and should be left unchanged.

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Right Eye Details

Left Eye Details

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