Please fill out form to the best of your ability and call with any questions 860 875-7336

We will need your PD-Interpupillary distance. Measured in mm. Your eyecare provider will have this information.  PD needed for Custom IFR, Custom IFR Plus and Custom IFR Magnetic. We will also need your seg height for Custom IFR Magnetic. This is also available from your eyecare provider.  Please call if you have any dificulty obtaining these measurements!

We will need an up to date eyeglass prescription for Custom IFR Plus and Custom IFR Magnetic. Within one year!

We will also need the type of plane you fly most! Manufacturer and Model. Also if you have a glass panel or a panel GPS on board for Custom IFR, Custom IFR Plus and Custom IFR Magnetic.

We will need your choice of lens color(Grey, Orange, Yellow or Clear) for Custom IFR.

We will need your chioce of frame color(Brown or Black) and sunglass lens color(Grey or Brown) for Custom IFR Plus.

* = Required Fields

*Name:	*first *last
*Address:
*City/Town:
*State:
*Zip Code:
*Telephone:
*Email:

*OD-Right	SPH:	CYL:	AXIS:	ADD:
Example	+2.25	-0.75	170	+2.00
*OS-Left	SPH:	CYL:	AXIS:	ADD:
Example	+1.75	-0.25	010	+2.00
*PD-Pupillary Distance: (this will be in millimeters) Should be between 52 to 74

Type of Aircraft

*Manufacturer:
*Model:
*I have a: Glass Panel or a Panel GPS or None

Custom IFR Plus

Please Chose a Frame Color: Brown or Black frame for Custom IFR Plus.

Please Chose a Sunglass Lens Color: Gray or Brown sunglass lens color for Custom IFR Plus.

Please Chose a Lens Type: Polarized or NON-Polarized sunglass lenses for Custom IFR Plus.

Comments: Please type the letters and or numbers you see in black into the box before you try to send.