Order Form

To order online, use the Shopping Cart.
To order by mail, print this form and send with your check to IMPA, 4144 Lyndhurst Court, Sarasota, FL 34235. Checks must be on a US bank in $US with machine-readable routing numbers at the bottom.

Educational Material and Glasses	Quantity	Total
The Myopia Myth: Softcover. Reveals the truth about the eye care business. $15		$
Kids' reading glasses: Indicate power and quantity. $50		$
Coiled head strap for use with reader. $3		$

Myopter	Model	Quantity
Myopter models: Temple, red, gray, green, yellow, orange, black. $200			$

Myopter Lenses	Power	Quantity
Myopter lenses: +3, 2.5, 2, 1.5, .5, plano, -.5, 1, 1.5, 2, 2.5, 3. $15 each			$
Myopter lenses: +3, 2.5, 2, 1.5, .5, plano, -.5, 1, 1.5, 2, 2.5, 3. $15 each			$
Myopter lenses: +3, 2.5, 2, 1.5, .5, plano, -.5, 1, 1.5, 2, 2.5, 3. $15 each			$
Myopter lenses: +3, 2.5, 2, 1.5, .5, plano, -.5, 1, 1.5, 2, 2.5, 3. $15 each			$

Myopter Lenses To Install	Right	Left
Indicate which power is to be installed for each eye.

Postage to countries outside the US. Add $30. Includes insurance.	$
Total	$

Nonstandard spherical lenses are $40 each on special order. To calculate the correct power of Myopter lenses,
see Close-up Lens Selection or use Email for assistance.

Shipping Information).
Enter a telephone number and/or email address in case of a question about your order.

Name:

Address 1

Address 2:

City:

State (if used):

Postal Code:

Country:

Email (will be kept private):

Telephone (will be kept private):

Date:

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