Period Glasses Order Form
On-line Order form if you would like to use the PDF Version please download it from our website
Styles
Frames Only
1
2
3
4
5
Please Pick Your Style
Frames & Lenses
1
2
3
4
5
Please Pick Your Style
Frames Only / Frames & Lenses
Tick the appropriate box
Frames Only (UK) £67.00 per pair
Frames & Lenses (UK) £127.00 per pair
Frames Only (Overseas) £73.00 per pair
Frames & Lenses (Overseas) £133.00 per pair
Please Read Me Carefully
Prices include postage and packing, and postage insurance for the UK only.
If you would like postage insurance for overseas, please contact me for a quote.

Please ensure that your (PD) Distance between left and right pupils is on your prescription. Ask your optician for this.

Fill in the above order form before using the paypal button. Check your detail before you submit your details.

If you are paying using the Paypal, make sure you fill out this form first.

Sending Payment Via Bank
Name: Nationwide Sort Code: 07-02-46 Account No:08371787

Please make cheques payable to:

Trevor Timms: 47 East Avenue, Nordley Hill, Wednesfield, Wolverhampton, WV11 1QE

Tel: 01902 827575 Mobile: 07830128451

Prescription Upload (Please ensure that your PD) is included *
Required
Address to send your order
Full Name *
Full Address With Postal Code *
Telephone Contact (Home or Mobile) *
Email Address *
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