 
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
42 Commerce Drive |
|
|
|
|
|
Farmingdale, NY 11735 |
|
DATE |
|
|
|
Phone 631-414-7002 |
|
|
|
|
Fax 631-414-7003 |
|
|
|
|
info@vircoloptical.com |
|
|
|
|
|
|
|
Name |
|
Ship To If Different From Billing Address |
|
|
Street Address |
|
Name |
|
|
|
City |
|
Street Address |
|
|
|
State / Zip Code |
|
City |
|
|
|
Daytime Phone |
|
State / Zip Code |
|
|
|
Cell Phone |
|
|
|
|
|
|
|
E-Mail Address |
|
|
|
|
|
|
|
SHIPPING METHOD |
|
|
|
|
USPS - Priority Mail |
|
|
|
|
All Sunglass Lenses are CR-39 Plano unless otherwise specified. Lenses
are sold in matched pairs we will match the color lens as close as possible |
|
|
to the original lens in your sunglasses we can not guarantee color will be
exact, However they will be as close as possible |
|
|
QTY |
|
DESCRIPTION |
|
|
UNIT PRICE |
LINE TOTAL |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Shipping & Handing charges for 48 US Continental States |
Shipping |
$6.95 |
|
|
|
|
SUBTOTAL |
|
|
|
Paypal Customers Include |
|
8.625% NYS Sales Tax |
|
|
|
Transaction # |
|
TOTAL |
|
|
|
|
|
|
|
Please Make all Checks & Money Orders Payable to
|
|
|
|
Vircol Optical |
|
|
All New York State Residents add 8.625% Sales Tax |
|
|
All Credit Card orders are payable through Pay Pal on Our Web Site |
|
|
|
Authorized by |
Date |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
 |
|
|
|