Ernst &
Michael
4327 18th St.
San Francisco
CA 94114
415.431.8020
Monday - Friday
11AM - 7PM
Saturday & Sunday
By Appointment Only
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Order Form
Account Name
Invoice Name
Patient Name
Redo Name
RE (OD)
LE (OS)
Sph
Cyl
Axis
Prism
BC
RE (OD)
LE (OS)
Add
Height
D.PD
N.PD
O.C.
A Box (Eye)
B Box
E.D.
DBL.
Frame Name
Frame Brand
Frame Type
<Select>
Zyl Edge
Metal Edge
Drilled Rimless
Grooved Rimless
Other
Thickness Type
<Lab Decide>
This as Possible
Industrial
Specify
Drill Holes
<Select>
2 Holes
4 Holes
Notch & Drill 2 Holes
Notch & Drill 4 Holes
IC Berlin
AIM Rim
Silhouette
Center Thickness
Lens Style
<Select>
SV
Progressive
FT 25
FT 28
FT 35
FT 45
Exec Bi
RD 22
RD 24
RD 28
Blended
Ultex
7 x 25
7 x 28
7 x 35
8 x 35
8 x 34
10 x 35
12 x 35
14 x 35
EDTRI
Smart Seg
Exec Tri
Progressive Style
<N/A>
Adaptar / Essilor / 24
AF / Pentax / 20
AF Mini / Pentax / 24
B' Active / AO / 20
Compact / AO / 17
Concise / S/A / 17
Fashion Fit / X-Cel / 17
Freedom / X-Cel / 22
Genesis / Shamir / 19
GP / Hoya / 18
GP Wide / Hoya / 17
Gradal Top / Zeiss / 18
Hyperview / Optima / 23
Image / Younger / 18
Kodak / SA / 22
Life II / Roden / 18
Life XS / Roden / 16
Multigressive / Roden / 18
Natural / Essilor / 20
Navigator / S/A / 22
Nav Short / S/A / 17
Omni / AO / 22
Outlook Vari / VE / 18
Ovation / Essilor / 17
P6 / Seiko / 24
Perfas / Pentax / 14
Percepta / Sola / 22
Piccolo / Shamir / 16
Precise / S/A / 20
Premier / VE / 20
Pro / AO / 22
Prog. AT / Roden / 18
Proceed / Seiko / 22
Proceed II / Seiko / 18
Shorty Pal / SLC / 16
Solamax / Sola / 22
Summit / Hoya / 16
Summit CD / Hoya / 14
Summit ECP / Hoya / 28
SNL / Essilor / 24
VIP / Sola / 22
Visuality / Sola / 22
XL / Sola / 22
Shorty Pal / SLC / 16
Solamax / Sola / 22
Summit / Hoya / 16
Summit CD / Hoya / 14
Lens Material
<Select>
Plastic / CR-39 1.50
Phoenix (Trivex)
Trilogy (Trivex Aspheric)
1.54 - 1.56
Poly 1.58
1.60
1.66
1.70
Photochromatic
<N/A>
Gray
Brown
Green
Fashion Purple
Fashion Blue
Fashion Aqua
Fashion Gray
Fashion Orange
Fashion Pink
Fashion Yellow
Polarized
<N/A>
Gray
Brown
Gray A
Brown A
Melanin
Yellow
Eagle
Green Apple
Sky Blue
Hi Contrast
Neutral Gray
Neutral Brown
Target Orange
Amber
Purple
Green
Vermillion
Blue
Anti-Reflection Coatings
<N/A>
Pentax Factory
Foundation XT : Extra Tough Hard Coat
Super ET : Super ET
Gold ET : Gold ET
Cool Blue : Cool Blue w/Gray 3 Base
Super ET Carat : Foundation XT + Super ET
Gold ET Carat : Foundation XT + Gold ET
Cool Blue Carat : Foundation XT + Cool Blue
UV Coating
Scratch Coating
Edge Polish
Hi Gloss
Satin Polish
None
Tint Color(s)
No Tint
Solid
Gradient
Double Gradient
Special Instructions...