PLEASE READ CAREFULLY BEFORE FILLING IN THIS FORM: Due to the curvature of the outer lens, Aviate glasses are not suitable for prescriptions with SPH (Sphere) or CYL (Cylinder) parameters greater than plus or minus 4.00.

Prescription orders can only be taken for customers within the United Kingdom.

Please take care to place a minus sign next to any parameters that have them marked on the prescription (sometimes these may be above the number concerned). C&M Rapid Ltd will not be responsible for incorrectly made prescriptions where information has been wrongly supplied by a customer.

Values marked with (*) are required.

Right Eye

SPH (Sphere): *


CYl (Cylinder): *


Axis: *


Near Add: *


Left Eye

SPH (Sphere): *


CYl (Cylinder): *


Axis: *


Near Add: *


PD (Pupillary distance):


Note - This information will only be supplied on the card if you have a non-standard PD. If it is not marked, leave this field blank.

Other Information:


Customer Name: *


Contact Telephone Number: *


Note – You will only be contacted by phone if a query arises from your order. We do not share your details with anyone else.

Tick to Confirm your details above *