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Liquid Polarized Prescription Eyewear
Full Name:  
Phone Number:  
E-Mail:  
Doctor's Name:  
Doctor's Phone Number:
Prescription Expiration:

For simplicity, please FAX YOUR PRESCRIPTION to (443) 339-0074, including the specifications, instead of filling out this optional information:

Pricing on prescription insert and lenses will be an additional charge separate from sunglasses. Please complete all purchases for other Liquid accessories and non RX sunglasses before ordering.

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Axis
OD/Right:
OS/Left:
 
 
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Bifocal/Right:  
Bifocal/Left:  

Pupilaric Distance:
(Measured in millimeters)		 Left:
 		 Right:
 
Segment Height:
(Bifocals Only)

Select a model:

 

Lens Options Price Select
Single Vision 149.00
Bifocal 199.00
Progressive Bifocal 299.00
 
Material Price Select
Polycarbonate included
Polished Edge included
Wrap Compensation (8 Base) included

Disclaimer:
RX lenses not available in Arizona.

Certain prescriptions with higher powers may require higher lens cost,
if this is the case we will contact you with a new quote.
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