ART-LENS

Orders:

L.C. ART-LENS Order

Trade Name:


Address:		Postal Code:


Location:		Telephone Number:


E-mail:		N.I.F.


Contact Person:


PARAMETERS:

Lens kind:	Lens power:	Lens radius:

Pupil diameter:	Iris diameter:	Total lens diameter:


Definitive lens:	Test lens:

COLOUR:

Lenses with base colours:	Iris colour reference nº:	Crown colour reference nº:


Pathology to treat:
Description:


Customized lenses:
Description for customized colour option (ask):


Attach an image:
Attach an image:
Attach an image:
(Please, send images in GIF or JPG format and smaller than 1Mb)

Art-Lens se compromete a respetar la privacidad de estos datos conforme a la ley orgánica 15/1999.

ART-LENS Paseig de Gracia 117 pral. 1ª 08008 BARCELONA Telf: 93 217 3168 Fax: 93 41 591 75 ocularistas@gmail.com