DT Non-RX Checkout

Order Form

Please fill out the form below and we’ll get your order going!

"*" indicates required fields

ORDER: Edge Kazbek XL (NO RX)

Quantity*

Please enter a number from 1 to 20.

Employee Information

Please enter your information below. As you are ordering non-prescription eyewear, there is no need to provide a prescription or PD distance. Simply complete the following steps to submit your order:

1. Verify your personal and shipping details.
2. Verify your preferred lens option.

Once you've submitted your order, we'll begin processing it and keep you updated on its status.

Employee ID*

Site Number*

First Name*

Last Name*

Birthdate*

Employee Contact Information

This information will allow us not to disturb business times and also inform the employee via text when their glasses are shipped.

Employee Cell Phone*

Employee Email*

Signature

In placing this order, I attest that I have received approval from my manager to order these glasses.

Magnification Strength*

This field is for validation purposes and should be left unchanged.

Order Form

Employee Information

Employee Contact Information

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