b'TO PLACE THIS ORDER ONLINE VISIT2025 RUDY PROJECT | RX PRICING *Does Not Include Plano Lenses 2025 RUDY PROJECT | RX ORDER FORM RUDYPROJECTDEALER.COM/RX**Deltabeat Price Includes Optical Dock***Rx Direct Available In Rx Shield Lens OptionsPRESCRIPTION PLEASE PHOTOCOPY AND REUSE FORMSPORT PERFORMANCE SPORT PERFORMANCE ACTIVE LIFESTYLE OPHTHALMICFRAMES US RETAIL CAN RETAIL FRAMES US RETAIL CAN RETAIL FRAMES US RETAIL CAN RETAIL FRAMES US RETAIL CAN RETAIL Account Name: Account #:AGENT Q* $270.00 $364.50 RYDON* $230.00 $310.50 GLAMSHADY* $130.00 $175.50 INKAS $255.00 $344.25 City: State/Zip:ASTRAL SPHERE*** $175.00 $236.25 RYDON SLIM* $230.00 $310.50 LIGHTFLOW A* $180.00 $243.00 INKAS XL $255.00 $344.25 1015 Calle AmanacerCUTLINE*** $230.00 $310.50 SIRIUS* $175.00 $236.25 LIGHTFLOW B* $180.00 $243.00 PULSE 53 $185.00 $249.75 San Clemente CA 92673 Faxed By: Phone #:Rx Department 888.860.7597DELTABEAT** $265.00 $357.75 STARDASH* $230.00 $310.50 OVERLAP* $130.00 $175.50 PULSE 54 $185.00 $249.75 Fax to 800.272.5118 Date: Patient:MAGNUS* $230.00 $310.50 TRALYX+*** $230.00 $310.50 SPINAIR 57* $160.00 $216.00NYAD* $175.00 $236.25 TURBOLENCE*** $230.00 $310.50 SPINHAWK EDGE* $155.00 $209.25PROPULSE* $175.00 $236.25 STELLAR* $130.00 $175.50 STEP 1 - ORDERNew Order Redo Original Order # Reason For RedoUS RETAIL CAN RETAIL STEP 2 - FRAME ***NO LENS ONLY ORDERS***RX LENS CHARGE RX LENS CHARGE A.Rudy Project ProvidedFrame To Come (Dealer Provided) Rudy Project is not responsible for frames lost in transitif they are not sent via a trackable shipping methodPHOTOCHROMIC Single Vision Progressive Single Vision ProgressiveImpactX(Clear 2 Black, Clear 2 Red ) $480 $580 $648.00 $783.00 B. Model: Color:Standard Trivex(Brown, Grey, Green) $480 $580 $648.00 $783.00Standard Polycarbonate(Brown, Grey, Green) $460 $560 $621.00 $756.00 C. Rx Type: Rx Direct in Frame Rx Insert Optical Dock Rx Inset Rx ShieldImpactX Laser Mirror & Backside AR(Clear 2 Laser Black,2 Laser Red, 2 Laser Brown, 2 Laser Purple) $500 $600 $675.00 $810.00 D. Rydon Shape: Classic Running GolfStealth Safety Thickness Curva (rydon slim) Xtra Active Trivex(Brown, Grey) $520 $620 $702.00 $837.00Xtra Active Polycarbonate(Brown, Grey) $500 $600 $675.00 $810.00 STEP 3 - LENSES(please select only one lens plus any optional add-ons)Xtra Active Polar Trivex(Grey) $620 $720 $837.00 $972.00Xtra Active Polar Polycarbonate(Grey) $600 $700 $810.00 $945.00 IMPACTRX PHOTOCHROMIC - 8 BASE ONLY (PROPRIETARY) PHOTOCHROMICMaterial:IMPACTX Material:TRIVEXPOLYCARBONATEPOLARIZEDImpactRX Photochromic 2 Black ImpactRX Photochromic 2 Laser Red (Blue Mirror)Photochromic GreyXtractive Photochromic GreyPolar 3FX - Polarized with Mirror and Backside ARImpactRX Photochromic 2 Laser Black (Silver Mirror)ImpactRX Photochromic 2 Laser Brown (Gold Mirror)Photochromic BrownXtractive Photochromic BrownTrivex(Blue, Green, Orange, Grey, Brown) $480 $580 $648.00 $783.00ImpactRX Photochromic 2 Red HDR ImpactRX Photochromic 2 Laser Purple (Blue Mirror)Photochromic G-15Xtractive Photo Polarized GreyPolycarbonate(Blue, Green, Orange, Red, Grey, Brown, Racing Red) $440 $540 $594.00 $729.00Standard Polarized POLAR 3FX - POLARIZED WITH MIRROR AND BACKSIDE A/R INCLUDED POLARIZEDTrivex(Brown, Grey) $440 $540 $594.00 $729.00 Material:TRIVEXPOLYCARBONATE Material:TRIVEXPOLYCARBONATEPolycarbonate(Brown, Grey, G-15, Red) $400 $500 $540.00 $675.00 Polar 3FX Multilaser Green (Grey w/Green Mirror)Polar 3FX Grey (Grey w/ Silver Mirror)Polarized GreyPolarized RedSTANDARDPolar 3FX Multilaser Blue (Grey w/ Blue Mirror)Polar 3FX Brown (Brown w/ Gold Mirror)Polarized BrownPolarized G-15 (Polycarbonate Only)Laser Mirror - Tinted with Mirror & Backside AR - (Black, Blue, Bronze, Racing Red, Sunset)Polar 3FX Multilaser Orange (Brown w/ Orange)Polar 3FX Racing Red (Red w/ Blue - Polycarbonate Only)Trivex $360 $460 $486.00 $621.00Polar 3FX Multilaser Red (Grey w/ Red Mirror - Polycarbonate Only)Polycarbonate $320 $420 $432.00 $567.00Transparent/Tinted STANDARD LASER MIRROR - MIRROR AND BACKSIDE A/R INCLUDEDTrivex $340 $440 $459.00 $594.00 Material:TRIVEXPOLYCARBONATE Material:TRIVEXPOLYCARBONATEPolycarbonate $300 $400 $405.00 $540.00Blue LightSmoke BlackOrangeLaser Black (Grey with Silver Mirror)Laser Bronze (Brown with Gold Mirror)OPHTHALMICS/INSERTSTransparentAction BrownLaser Blue (Grey with Blue Mirror)Laser Sunset (Grey with Sunset Mirror)Trivex $220 $320 $297.00 $432.00YellowGolf 100Laser Copper (Copper with Silver Mirror)Racing Red (Red with Blue Mirror)Polycarbonate $160 $260 $216.00 $351.00 Zeiss BioChrom+ RX SHIELD - Astral Sphere | Cutline | Tralyx + | TurbolenceBlue Light Polycarbonate $260 $360 $351.00 $486.00 Material:TRIVEXPOLYCARBONATE Material:POLYCARBONATEADD ONSRefresh / BlueFocus / Yellow STANDARD LASER MIRROR PHOTOCHROMICBackside A/R $65 $65 $87.75 $87.75Relax / GreenBoost / RedTransparentSmoke BlackRacing Red (Red with Blue Mirror) Photochromic GreyFull A/R $100 $100 $135.00 $135.00YellowAction BrownLaser Blue (Grey with Blue Mirror) MIRROR ADD-ONS (optional)Blue Light A/R $100 $100 $135.00 $135.00 OPTIONAL ADD-ONSOrangeGolf 100Laser Black (Grey with Silver Mirror)Blue MirrorMirror with A/R $100 $100 $135.00 $135.00A/R FullA/R BacksideA/R Blue Light POLAR 3FX - POLARIZED WITH MIRROR AND BACKSIDE A/R INCLUDEDGreen MirrorXtra Active Mirror with A/R $155 $155 $209.25 $209.25A/R BL TintedCustom TintLenticular ThinningPolar 3FX Multilaser Green (Grey w/ Green)Polar 3FX Grey (Grey w/ Silver)Red MirrorTint $25 $25 $33.75 $33.75Solid Mirror - Red, Blue, Green, Silver, Gold, Black, CobaltPolar 3FX Multilaser Blue (Grey w/ Blue) POLARIZEDGold MirrorThinning $50 $50 $67.50 $67.50Flash Mirror - Blue, Green, Silver, Gold, Black, Rose Gold Polar 3FX Multilaser Orange (Brown w/ Orange)Polarized GreySilver MirrorRX SHIELD-Astral S | Cutline | Tralyx + | TurbolenceXtractive Mirror - Blue, Red, Green, Silver, Gold, Pink Polar 3FX Multilaser Red (Grey w/ Red)Polarized BrownTransparent/Tinted $490 $590 $661.50 $796.50 STEP 4 - PRESCRIPTIONLaser (with mirror) $560 $660 $756.00 $891.00Rx Lens Type: MINIMUM SH PAL 15 FOR RX SHIELD LENSPolarized $630 $780 $850.50 $1,053.00 SPHERE CYLINDER AXIS PD ADD SEG HEIGHT SIZE PRISM OC HEIGHTPolarized (with mirror) $700 $850 $945.00 $1,147.50Single Vision ODPhotochromic $695 $845 $938.25 $1,140.75Photochromic (with mirror) $765 $915 $1,032.75 $1,235.25ProgressiveCustom Mirror $70 $70 $94.50 $94.50 OSLined Bifocal and Inverted / Shooting lenses also available please call for detailsPrices are subject to change without notice. Always consult our Rx Department for full fitting and lens options.Special Instructions: 95'