Basic Online Ordering Form 
​Rx Billiard Rimless Glasses

(Take Advantage By Using Your Flex Spending or Health Savings Card)
FREE Two Year Protection Plan ($50.00 Value)
​100% Customer Satisfaction Guarantee!
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Click to View Protection Plan
    Step #1: Select Your Promotion
    ​When we contact you, please let us know what T-shirt size you prefer. Available Sizes: Small, Medium, Large, XL, 2XL.
    Step #2: Patient Information
    Step #3: Shipping & Billing Information
    (If "No'", Please enter billing information below)

    Step #4: Waiver

    Click HERE to Read Our Rx Adaption Policy.
    Step #5: Upload Rx & Photos of Yourself
    Please email or upload a copy of the original Rx. We will not process the order until we receive a copy of your prescription.
    Email: billcurran2020@gmail.com
    Max file size: 20MB
    Max file size: 20MB
    Max file size: 20MB
    Max file size: 20MB

    Step #6:​ Select a Frame Design

    - Each Frame Collection Can Be Viewed Below Under Their Available Colors -
    Step #7: Selecting a Frame Color 
    - For Frame Color Purposes Only -
    ​If you clicked on the 'not sure' option, then we will recommend a frame color once we receive your photos.

    ​Note: Certain colors work best with certain hair colors and facial complexions. 
    - Frame Colors Below are for Original Series Only - 
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    Solid Black
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    Brown
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    Satin Gold
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    Blue
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    Silver & Black
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    Grey
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    Purple
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    Wine
    - Frame/Colors Below are for Pro Series Only -
    - For Frame/Color Purposes Only -
    Note: Only ONE color available for each (5) ​Pro Series styles.
    ​If you clicked on the 'not sure' option, then we will recommend a frame/color once we receive your photos.
    Note: Certain frame/color work best with certain hair colors and facial complexions. 
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    Match (Color: Navy)
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    Lite Twist (Color: Black Shadow)
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    Racing (Blue/Orange)
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    Accent (Color: Gold & Black)
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    Fusion (Satin Black/Gold)
    Step #8: Select a Lens Shapes (6 Available) 
    All of our work is customized. Once we receive the four (5 optional) close up photos, we will email or call you and discuss lens shapes that we recommend. If desired, we can email a superimposed image of the lens shape over the photo you sent us for a general idea on how they will look.
    These lenses are not one-size-fits-all.
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    Lens Shape: 'Sport'
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    Lens Shape: 'Angles'
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    Lens Shape: 'Classic'
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    Lens Shape: 'Cue Ball'
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    Lens Shape: 'Cosmo'
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    Lens Shape: 'Diamond'
    Step #9: Select a Case (Two Cases Available)
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    'Standard' (Hard Case)
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    'Deluxe' (Soft Case w/ Belt Loop)
    Step #10: Select Your Lens Type
    Submit Form By Clicking Button Below
    Note: All fields with an **** are a mandatory field. Forms won't go through otherwise. 
    Make sure to hit the submit button when you're finished. If mandatory fields are left unanswered, they will be circled in red.