NU-CLIP LENS ORDER FORM by malj

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									                                                                   NU-CLIP LENS ORDER FORM
                                                                  713 W DUARTE RD #G-518 ARCADIA, CA 91007
                                                   TOLL#: 1-800-923-CLIP TEL#:(626) 821-0816 FAX#:(626) 821-4466
                                                                                    WEB SITE: WWW.NUCLIP.COM



   BILL TO:

   SHIP TO:

  CONTACT:                                                  E-MAIL:

     Tel :                                                   Fax :

 Order Date                                                  P.O #


   SHIP VIA
                 USPS      Express mail (next day )     Priority Mail 2-3 days /   Courier (CA only )
                    Please use receiver’s account #______________________with   Fedex  UPS


                            POLYCARBONATE LENS                 POLARIZED LENS
                                  (PAIR)
       LENS COLOR           REGULAR          AR           NON AR                AR

DARK BROWN        80%                                                           N/A
DARK GREY         80%
DARK GREEN (G-15) 80%                                                           N/A
NIGHT DRIVING (AMBER)         N/A                            \
                                                            N/A                  \
                                                                                N/A
    SILVER MIRROR             N/A                           N/A                 N/A
     BLUE MIRROR              N/A                           N/A                 N/A

GRADIENT LENS (PAIR )
   GRADIENT DENIM
    GRADIENT ROSE
     GRADIENT TAN
  GRADIENT ORANGE
   GRADIENT PURPLE
   GRADIENT PEACH
   GRADIENT YELLOW
    GRADIENT OLIVE
    GRADIENT JADE
   GRADIENT MAUVE
    GRADIENT SAGE

								
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