RX - Modulo d’ordine | Order Form LENTI SU PRESCRIZIONE - Somma Sfera + [Cilindro] ( attenzione al valore massimo indicato) PRESCRIPTION LENSES - Sum of Sphere + [Cylinder] (pay attention to the maximum indicated value)
Sph. +4.00/-6.00 Cyl. 2
Sph. +8.00/-11.00 Cyl. 4
Lente CR39 1.433 HC 12002L0 Swimmy Dark Purple 12003L0 Swimmy Black 12004L0 Swimmy Transparent Blue 12005L0 Swimmy Transparent Purple 12006L0 Swimmy Transparent Green
Sph. +11.00/-20.00 Cyl. 4 Lente H.I. 1.74 HC
Lente H.I. 1.60 Asferica HC 12002L3 Swimmy Dark Purple 12003L3 Swimmy Black 12004L3 Swimmy Transparent Blue 12005L3 Swimmy Transparent Purple 12006L3 Swimmy Transparent Green
12004L5 Swimmy Transparent Blue 12005L5 Swimmy Transparent Purple 12006L5 Swimmy Transparent Green
o
Sph. +8.00/-8.00 Cyl. 4
Sph. +10.00/-14.00 Cyl. 4
Lente CR39 1.433 HC 12002L1 Swimmy Dark Purple 12003L1 Swimmy Black 12004L1 Swimmy Transparent Blue 12005L1 Swimmy Transparent Purple 12006L1 Swimmy Transparent Green
o Occhio Destr Sf
Occhio Sinistr Sf Asse Per distanza
Cyl.
A permanenza
Lente H.I. 1.67 Asferica HC 12002L4 Swimmy Dark Purple 12003L4 Swimmy Black 12004L4 Swimmy Transparent Blue 12005L4 Swimmy Transparent Purple 12006L4 Swimmy Transparent Green
Asse
Cyl.
Per Vicino 90° 90° 120°
30°
150°
0° 180°
120°
60°
60° 30° 0°
120° 150° 180°
90° 60°
150° 30° 0°
180°
LARE mm D. INTERPUPIL
Limiti massimi di prescrizione: vedi gruppo L5 Maximum prescription values: please refer to group L5
A. Inserisci i dati delle lenti | Enter lens data
Codice cliente | Client code
Indicare il valore di cilindro negativo - Cylinder - Please indicate negative values only OCCHIO SINISTRO/ LEFT EYE
OCCHIO DESTRO/ RIGHT EYE Sfero/ Sph.
Cilindro/ Cyl.
Asse/ Axis
Sfero/ Sph.
RX
PD OD/ PR RE
Cilindro/ Cyl.
PD OS/ PR LE TABO
B. Scegli il colore [x] | Choose the colour [x]
Blu trasparente Trasparent blue
Verde acqua trasparente Trasparent green
Viola scuro Dark purple
Nero lucido Shiny black
C. Invia l’ordine tramite e-mail | Send order by e-mail Invia il modulo in allegato all’indirizzo: nuotopersonalizzato@centrostyle.it Tempi di consegna previsti: 10-20 giorni lavorativi, in base al numero di richieste. Send the order form to the following address: exportdpt@centrostyle.it Estimated delivery time: 15-22 working days, according to the number of requests.
Viola trasparente Trasparent purple
Asse/ Axis