Thank You

Order for Prescription Billiard Eyeglasses from Gordon Harrison, Dispensing Optician
		Unit Price	Amount
	Prescription Billiard Eyeglasses Anti-Reflective Coating Ultra-Thin Lenses	169.00 CND$ + 49.95 CND$ + 49.95 CND$	169.00
Use The Personal Currency Assistant™ to convert to your currency

Where to send the order.

Ship to Name:

Ship to Address:

Ship to City:

State/Province, Country	Ship to Country
Zip/Postal Code:	Ship to Phone:

Credit card receipt name and address
(if different from the Ship to Name)
Name: if different from Ship to:

Address:

City:

State/Province	Country:
Zip/Postal Code:	Phone:

Important:
Your Name: required (as on credit card)

Important:
Your email: required (For order confirmation)

Card Number (We accept Visa & MasterCard)

Expiry Expiry

Prescription Information
We need all this information to complete your order

	Sphere	Cylinder	Axis
Right Eye
Left Eye
PD
Click on >>