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4. FAX BACK TO: 262-547-3736. Eyewear Educator Portfolio Version Eyewear Educator Portfolio Version 2.0 SELECTION FORM 1. PRINT THIS FORM. 2. CHECK THE BOXES TO CREATE YOUR “FAVORITES” LIST. 3. PROVIDE THIS INFORMATION: Date: Clinic Name: Contact Name: Phone: Email: 4. FAX BACK TO: 262-547-3736. Customize your lens options by following the instructions below. Selecting Lenses: Please select the Lens Designs and Lens Coatings that you use. Pre-assigned options are pre-checked for bifocal, single vision, single vision aspheric, single vision high definition and trifocal. Selecting Frames: Please select the frame brands you use. If you do not see a vendor you currently dispense, indicate in the space next to “Other”. We will create requests to add new selections and update your custom “favorites” list. Selecting Second Pair Savings Promotion: Select the promotion offered at your clinic. If you have a different promotion you wish to add, indicate in the lines next to “Other”. Your logo and clinic information will be custom imprinted in one color (black) on your Eyewear Educator Portfolio after brochures are ordered online. Additional clinic information such as Office Hours or Clinic Warranty can also be custom printed on the center back panel. This information can be faxed, emailed or attached as a file document when placing your order. Your logo file artwork should also be attached at time of placing your order. Questions: Call Ziegler Visionary Marketing, 414-255-5852 1 REV 04-09-20 V2 LENS DESIGNS (SELECT ALL THAT APPLY): Eyezen Acclaim Single Vision Eyezen Plus Acuity HD Eyezen Start Bifocal Flex Plus BluTech Flex Single Vision Bolle Progressive G PAL Bolle Single Vision Generic PAL CompuClear Computer Hoya Amplitude Computer Lenses Hoya Array Costa 400P Progressive Hoya Array II Costa 400P Single Hoya GP Costa 580G Progressive Hoya GP Wide Costa 580P Progressive Hoya High Def Costa 580G Single Hoya iD Close Costa 580P Single Hoya iD Screen Crystal Hoya iD Single Vision Crystal CHD Hoya iD Space Definity Hoya Infinity Definity 3 Hoya Infinity Advanced Definity 3 Plus Hoya iQ Single Vision Definity Short Hoya Kid's Single Vision Digital Progressive Hoya iD Lifestyle Indoor Digital 5.0 Flex Plus single vision lenses Hoya iD Lifestyle Outdoor Digital 5.0 Flex single vision lenses Hoya iD Lifestyle Urban emPower Hoya LifeStyle 2 Clarity (formerly Hoya Lifestyle ID) Essilor 360 Hoya LifeStyle 2 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