Loupes Catalogue
ORDER FORM 2024
Date: User Name: User Surname:
Year of Birth (YYYY):
1983 Age:
41
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MAGNIFICATION AND WORKING DISTANCE
mm
300
350
400
450
500 550
600
700
600 and 700mm Working distances are only available to 2.5x and 3.0x galilean loupes and only for the following frames: ITA and ONE
2.0x Pro HD 2.5x Pro HD 3.0x Pro HD 3.5x Pro HD 3.5x Ultra HD 4.0x Ultra HD 5.0x Ultra HD
Galilean
Prismatic
3.5x 4.5x 5.7x
Ergo Advanced
FRAME
Look
Ruby
Emerald
Cool
Ruby
Emerald
Techne
White/Red
Black/Green
White/Pink
Black Edition
Techne RX
White/Red
Black/Green
White/Pink
Techne ASIAN FITTING
White/Red
Black/Green
White/Pink
Black Edition
Techne RX ASIAN FITTING
White/Red
Black/Green
White/Pink
Ash 55-17
Black/Red
Grey/Grey
Purple/Grey
Ash 53-17
Black/Red
Grey/Grey
Purple/Grey Green Vespa
ITA
Midnight Blue Desert Sage
Brown Endura
Black Edition
ONE
Black Edition /Limited Edition
Color Kit
CUSTOMIZATION (MAX 17 DIGITS) None Case: Frame:
Note:
PRESCRIPTION IN CARRIER LENSES (A)
HEADLIGHTS
** Carrier lenses: NEUTRE ; Optics: NEUTRAL. Loupes will come 100% without any prescription, as in a demo unit. Make sure the customer wears contacts lenses while * Carrier lenses: NEUTRE ; Optics: according to prescription supplied and age, for optimal working distance setting.
Neutral*
LYNX
Neutral but with contact lenses**
LYNX PRO
Distance
EOS Wireless
If you have chosen one of the options above, don't forget to add the magnetic adapter
Intermediate*** Reading Bifocal
***provide prescription for intermediate, otherwise the standard intermediate is calculated at 70cm.
Custom Magnetic
attach the original copy of the prescription, or fill the chart below
SAFETY VISORS
Right Eye
Left Eye
701 Overloupes
Cyl
Sph
Cyl
Axis
Sph
Axis
Distance Interm. Reading Add*
710 Overloupes
*mandatory for ERGO ADVANCED
DECLINATION ANGLE (OPTIONAL*)
22°
MAX*
18°
*If not filled, MAX (steepest) declination is the default setting.N/A for ERGO
IPD MEASUREMENT
RIGHT EYE*
LEFT EYE*
TOTAL
2° meas.
1° meas.
2° meas.
3° meas.
1° meas.
3° meas. 1° meas. 2° meas.
3° meas.
0,0
0,0
0,0
INFINITE VIEWING
* Per single eye, 2 values out of 3 measurements must be the same, and maximum 0,5mm of difference among the 3 measurements is accepted
Picture number:
Sales Agent Signature
Customer Signature
Rev 3 11.24
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