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 Harmony (formerly Hoya Lifestyle ID)  Essilor Accolade  Hoya MyStyle  Essilor Accolade Freedom  Hoya Summit CD  Essilor Adaptar  Hoya Summit ECP  Essilor Adaptar Digital  Hoya Summit iQ  Essilor Antifatigue  Hoya Summit Office Pro  Essilor Computer  Hoya SYNC Single Vision  Essilor Ideal  Hoya Tact  Essilor Ideal Advanced  Hoya Trinity  Essilor Ideal Advanced Wrap  Hoyalux Summit Premium  Essilor Ideal Short  Illumina  Essilor Interview  Image  Essilor Natural  KBCo EOS  Essilor Natural Digital  KBCo Fusion  Essilor Ovation  Kodak DSII  Essilor Ovation Digital  Kodak Total Blue  Essilor Small Fit  Kodak Unique DRO  Essilor Small Fit Digital  Kodak Unique DRO HD  Ethos Progressive  Kodak Unique HD   Maui Jim Passport Digital Progressive Ethos Plus Progressive 2  Maui Jim Progressive  Shamir Autograph II Single  Maui Jim Single Vision  Shamir Autograph III  MOD PAL  Shamir Autograph III Fashion  My Focal HD  Shamir Autograph III Single  Navigator  Shamir Stylistic  Navigator Short  Shamir Computer  Nikon Home & Office  Shamir Creation  Novel  Shamir Duo  Novella Progressive  Shamir Element  Oakley Digital  Shamir FirstPAL  Oakley Bicycling Progressive  Shamir Genesis  Oakley Fishing Progressive  Shamir Golf Progressive  Oakley Golfing Progressive  Shamir Golf Single  Oakley Progressive  Shamir InTouch  Optima Hyperview  Shamir Office  Peak HD  Shamir Piccolo  Pentax AF  Shamir Relax  Pentax AF Mini  Shamir Spectrum  Puresite Easy Fit  Shamir Spectrum Single  Puresite Enhanced  Shamir WorkSpace  Puresite Premier  Shamir Xpanse  Puresite Ultima  Shaw Aniseikonic  Rodenstock EyeLT  Shoreview  Rodenstock Impression Ergo  Shoreview Mini  Rodenstock Impression FreeSign 2  Signet Armorlite Kodak Concise  Rodenstock Impression Hyperop-Myop  Signet Armorlite Kodak Digital  Rodenstock Impression Mono Plus 2  Signet Armorlite Kodak Monitorview  Rodenstock Impression Mono2  Signet Armorlite Kodak Navigator  Rodenstock Impression Sport  Signet Armorlite Kodak Navigator Short  Rodenstock Sport Polarized  Signet Armorlite Kodak Precise  Rodenstock Sport Polycarbonate  Signet Armorlite Kodak Precise PB  Seiko PC Wide  Signet Armorlite Kodak Softwear  Seiko Proceed II  Signet Armorlite Kodak Unique  Seiko Proceed III  Signet Armorlite Kodak Unique DS  Seiko Supercede II  Single Vision Aspheric  Seiko Supernal  Single Vision  Seiko Surmout  Single Vision Digital  Seiko Surmout WS  Single Vision High Definition  Shamir Attitude Progressive  Summit HD  Shamir Attitude III Sport  Trifocal  Shamir Attitude III Fashion Progressive  TruClear  Shamir Autograph II  TruClear AR  Shamir Autograph II Attitude  TruClear Palz  Shamir Autograph II Attitude Single  TruClear SD  Shamir Autograph II Office  TruClear SD2 3  TruClear XD  Varilux Physio Enhanced W3 Fit  TurClear XD2  Varilux Physio Short  Ultimate B  Varilux Physio Short DRX  Unity Computer  Varilux S 4D  Unity CVx  Varilux S Design  Unity CVxpression  Varilux S Fit  Unity Office Pro  Varilux Sport  Unity PLx  Varilux Stylistic  Unity PLxpression  Varilux X 4D  Unity PLxtra  Varilux X Design  Unity PLxtreme  Varilux X Fit  Unity Single Vision  VisionEase Outlook  Unity SVx  Viso Pro  Unity SVxtra  X-cel Fashion Fit  Unity SVxtreme  X-cel Fashion ID  Unity Via  Younger Adage  Unity Via Elite  Younger Image  Unity Via Mobile  Zeiss AO Compact  Unity Via Plus  Zeiss AO Compact Ultra  Unity Via Wrap  Zeiss AO Compact Ultra HD  Unity VSP Reveal  Zeiss AO Easy  Varilux Comfort  Zeiss AS  Varilux Comfort DRX  Zeiss Business  Varilux Comfort Enhanced  Zeiss Choice  Varilux Comfort Enhanced Fit  Zeiss Choice Plus  Varilux Comfort Enhanced W3  Zeiss Classic  Varilux Comfort W2+  Zeiss Continuum  Varilux Comfort W2+Fit  Zeiss Digital  Varilux Comfort Short  Zeiss Gradal Brevity  Varilux Comfort Short DRX  Zeiss Gradal RD  Varilux Ellipse  Zeiss Gradal Top  Varilux Ellipse 360  Zeiss GT2  Varilux Eyecode  Zeiss GT2 3D  Varilux Ipseo  Zeiss GT2 Short  Varilux Ipseo IV  Zeiss Individual  Varilux Overture Computer  Zeiss Individual 2  Varilux Overture PAL  Zeiss Instinctive  Varilux Physio  Zeiss MyoVision  Varilux Physio 360  Zeiss Officelens  Varilux Physio 360 Short  Zeiss Officelens Individual  Varilux Physio DRX  Zeiss Officelens Plus  Varilux Physio Enhanced  Zeiss Officelens Superb  Varilux Physio Enhanced Eyecode  Zeiss Plus 2  Varilux Physio Enhanced Fit  Zeiss Precision Plus  Varilux Physio Enhanced W3  Zeiss Precision Pure 4  Zeiss Precision Superb  Hoya Super Hi-Vision  Zeiss Sola Access  Hoya Super Hi-Vision EX3  Zeiss Sola Compact Ultra  Kodak Clean N CleAR  Zeiss Sola One  Kodak CleAR  Zeiss Sola One HD  Kodak Total Blue  Zeiss Sola VIP  Komodo  Zeiss SolaMax  Komodo Extreme  Zeiss Spherical  Komodo VES  Zeiss Sport  Maui Jim AR  Zeiss Superb - Progressive  NeuroBlue  Zeiss Superb - Single  Neurolens Premium  Zeiss SV Individual  Neurolens Premium Plus  Zeiss Synchrony  Nikon SeeCoat Blue  Nikon SeeCoat Plus LENS COATINGS (SELECT ALL THAT APPLY):  Oakley AR  Acclaro  Oakley Prizm  Backside AR  Oakley Prizm Iridium  Blue Crystal  Oakly Iridium AR  Clarion Blue  Radiance  Clarion XS  Reflection Free NP  Clarion XS Plus  Retinal Bliss  Claris AR  RF Endura  ClearSight  RF Endura EZ  ClearSight Claris  Rigel  ClearVu AR  Rodenstock Solitaire Protect Plus  Crizal Alize UV  Scratch Resistant Coating  Crizal Avance UV  Sentinel Plus AR  Crizal EZ UV  Shamir AR  Crizal Kids UV  Shamir Claris Plus AC  Crizal Prevencia  Shamir Glacier Plus AR  Crizal Sapphire UV  Sharper Image Techshield AR  Crizal Sunshield UV  Sharpview  Crizal Sunshield UV Mirror  Sharpview +  Crizal UV Optifog  Sola Teflon  Duravision Sun AR  Somo  FogBlok  Somo UltraClear  Generic AR  Somo Blue Block UltraClear  Glacier Plus UV  Summit Radiance Extreme  Hoya Array  TD2  Hoya Blue Control  TD2 Optifog  Hoya Clarity Shield  Techshield  Hoya Hi-Vision Long Life  Techshield UVR  Hoya Hi-Vision View Protect  Techshield Blue UVR  Hoya Premium Backside AR  Techshield Elite  Hoya Recharge  Techshield Elite UVR 5  Techshield Plus  Alexander Daas  Techshield Plus UVR  Altair  Teflon Clear Coat  Andy Wolf  Teflon Elite  Anglo American  Unity  Ann Taylor  Unity Blutech  Anna Sui  Unity Classic  Anne et Valentin  Unity Elite  Anne Klein  Unity Elite UV  Apple Bottom  Unity Plus  Argyleculture  Unity Techshield anti-reflective  Aristar  Viso  Armani Exchange  Viso Prevencia  Article One  Viso Pro  Aspex  Viso XC  Aspex Easy Clip  Viso XC Plus  Aspex Magnetite  Viso XC Plus UV  Aspire  Xperio UV  Augusto Valentini  Zeiss Allure  Autoflex  Zeiss Carat Advantage  Avantek  Zeiss Duravision Blue Protect  Avanti  Zeiss Duravision Chrome  Awear  Zeiss Duravision Platinum  Axel S.  Zeiss Duravision Silver  Baby Banz  Zeiss Duravision Sun  Badgley Mischka  Zeiss PureCoat Plus  Balenciaga  Banana Republic FRAMES (SELECT ALL THAT APPLY):  Barton Perreira 1 & 2  BCBG 141 Frames  BeauSoleil  29 Below  Bebe  3M  Bellagio  7Seven  Bellinger  A&A Optical  Betsy Johnson  Ad Lib  Bevel  Adensco  Biggu  Adidas  Big Mens Eyewear Club  Adin Thomas  Blac  Adrienne Vittadini  Blackfin  Affordable  Blaine & Taylor  Aframe  Blinde  Airlock  Blink  Airmag  Bliss  Alain Mikli  Bloom  Alexander  Blue Ribbon 6  BMW  CFX  Bobbi Brown  Champion  Bolle  Chanel  Bongo  Change Me  Bon Vivant  Chantal Thomass  Kodak Total Blue  Chaps  Boss  Charles Stone  Boss Orange  Charmant  Bostonian  Charmant Titanium  Bottega Veneta  Chemistrie Clip Readers  Boucheron  Chesterfield  Boutique Totally Rimless  Chloe  Brendel  Chopard  BrillenEyes  Christian Dior  Brooklyn Heights  Christian Lacroix  Brooks Brothers  Chrome Hearts  Buffalo  Cinzia  Bulova  Claiborne  Burberry  Claiborne for Men  Burton Morris  Claire Goldsmith  Bvlgari  Classic Stainless  C-Zone  ClearVision  Caseys Cove  ClearVision XL Fit  Cadillac  Clip & Twist  Café Boutique  Clip Tech  Café Lunettes  Club Level Designs  Callaway  Coach  Calligraphy  Coco & Breezy  Calvin Klein  Coco Song  Calvin Klein Jeans  Cogan  Candie’s  Cole Haan  Cantera  Coleman  Cargo  Colibris  Carolina Herrera  Color in Optics  Caroline Abram  Columbia  Carrera  Comfort Flex  Cartier  Converse  Casanova  Core  Cashmere  Costa Del Mar  Casino  Cote D'Azur  CAT/Caterpillar  Covergirl  Catherine Deneuve  Crayola  Caviar  Cremieux  Cazal  Crocs  Celine  Crush 7  Cruz  Elite Eyewear  Cutter & Buck  Ella  Cynthia Rowley  Elle  Dakota Smith  Ellen Tracy  Dale Earnhardt Jr.  Emilio Pucci  Dana Buchman  Emozioni  Danish  Emporio Armani  Danny Gokey  English Laundry  David Benjamin  Enhance  David Spencer  Entourage of 7  David Yurman  Epos  Davis  Erin's World  db4k  Ermenegildo Zegna  Denim  Ernest Hemingway  Derapage  Escada  Derek Lam  Esprit  Destiny  Esquire  D&G  Etnia Barcelona  Diesel  Europa  Dilli Dalli  Evatik  Dior  Exces  Diplomat  Exclusive  Disney  Eyebob  Dita  Eyenigma  Diva  Eye On  DKNY  Eyes of Faith  Dolabany  eyeOs  Dolce & Gabbana  Face a Face  Donna Fontana  Faconnable  Dragon  Fatheadz  Draper James  Feb 31st  Ducks Unlimited  Fendi  Durango  Ferragamo  Dutz  Fetch  DVF Diane Von Furstenberg  Fiori Collection  Easy Clip  Fisher-Price  Easy Twist  Flair  Eclectico  Flex-Lite  Eco  Flexon  Ed Hardy  Float  Eddie Bauer  Focus  Eight to Eighty  Fossil  Elan  Francis Klein  Elasta  Fregossi  Elegante  Freudenhaus 8  Frost  Ice Cream  Fundamentals  Iconik  FYSH  i-dealoptics  Gallery  iGreen  Gant  Imago  Gargoyles  Inface  Garrett Leight  Innotec  Genesis  Innovation  Geneviève Boutique  Invu  Geoffrey Beene  Isaac Mizrahi New York  Gigi  Italee 2.5  Giorgio Armani  Italee Kawasaki  Giovani di Venezia  Italia Independent  Givenchy  IZOD  Glacee  Jac and Jack  Gloria Vanderbilt  Jack Spade  Go Green  Jackson Rogers  Gold and Wood  Jacques Durand  Golf Flex  Jaguar  Google Glass  Jai Kudo  Gotti  Jalepenos  Grace  Jean Lafont  Greg Norman  Jelly Bean  Gridiron  Jennifer Lopez  Gucci  Jessica McClintock  Guess  Jessica Simpson  Gunnars  JF Rey  Gwen Stefani  Jhane Barnes  GX by Gwen Stefani  Jill Stuart  Hackett  Jimmy Choo  Haggar  Jimmy Crystal New York  Hamburg  JLO  Harley-Davidson  Joan Collins  Hart Schaffner & Marx  Joe  Headlines  John Lennon  Helium  John Varvatos  Hello Kitty  Jonathan Adler  Hershey  Jones New York  Hickey Freeman  Joseph Abboud  Hot Kiss  Jubilee  Hoya Safety  Judith Lieber  Hugo Boss  Juicy Couture  Humphreys  Julbo  Hush Puppies  Junction City  ic! berlin  Just Cavalli 9  Kaenon  Liu Jo  Kala  Liz Claiborne  Kamuro  London Fog  Kata  Loree Rodkin  Kate Spade  Louisluso  Kate Sylvester  Lucky Brand  Kay Unger  Lulu Guinness  Kenmark  Lunor  Kenneth Cole  Luxottica  Kenneth Cole Reaction  Mad in Italy  Kensie  Madison Montgomery  Kenzo  Magic Clip  Kid's Bright Eyes  Manhattan  Kilsgaard  Manish Arora  Kilter  Marc Ecko  Kio Yamato  Marc Hunter  Kirk  Marc Jacobs  Kishimoto  Marchon  Kliik Eyewear  MarchoNYC  Koali  Marcolin  Konishi  Marie Claire  Kool Kids  Bolle Single Vision  LA Eyeworks  Mario Galdatti  Lady Danielle  Markus T  LaFont  Martin & Martin  La Scala  Masunaga  Lacoste  Match  LaMatta by Poets  Matisse  L.A.M.B  Matsuda  L'Amy  Maui Jim  Laura Ashley  Maui Jim Opthalmics  Legacie  Max Mara  Legre  Menizzi  Levi's  Metal  Liberty  Metro  Liberty Sport Switch  Mexx  Library  Michael Kors Eyewear  Liebeskind  Michael Ryen  Lido West  Minima  Life is Good  Miraflex  Lightec  Miu Miu  Lilly Pulitzer  Miyagi  Lindberg  Modern  Line Art  Modern Art  Lipstick  Modo 10  Modz  Outspoken  Monoqool  Ovvo  More and More  OWP  Morel  O&X New York  Mossimo  Oxydo  Mykita  Panoptx 7Eye  My Little Pony  Paolo Belle  Nanovista  Paolo Seminara  NASCAR  Paradox  Nat & CoCo  Patient’s Own Frame  National  Paul & Joe  Nautica  Paul Frank  NBA  Paul Smith  Neostyle  Peace  Nero Lunettes  Pentax  neubau  Pepe Jeans London  New Balance  Perry Ellis  New Globe  Persol  New York Eye  PEZ  Nickelodeon  Pierre  Nicole Miller  Pinnacle  Nike  Plastic  Nina Ricci  Plastic or Metal  Nine West  Plume  Ninja Turtle  Polaroid  Nomad  Police  Norma Kamali  Polo  Nouvelle Rogue  Porsche Design  NRG  Port Royale  NW 77th  Prada  O!O by Tura  Precision  Oakley  ProDesign  ÖGA  Proof  OGI  Puma  Oliver Peoples  Puriti Titanium  Oliver Peoples - Sir Series  Puzio Eyewear  Onguard Safety  Quicksilver  Ooh La La  Raen  OP (Ocean Pacific)  Rag & Bone  Optimode  Ralph Lauren  Orbit  Rampage  Orgreen  Randolph  Original Penguin  Randy Jackson  Otego  RayBan  Otis & Piper  Reality 11  Real Tree  Sight for Students  Rec Specs  Sigrid Olsen  Red Paris  Silhouette  Red Rose  Skaga  Reebok  Skechers  Reeva  SLR  Reflections  Smart  RES REI  Smith Optics  RetroSpecs  SocialEyes  Revlon  Soho  Revo  Sophia Loren  Revolution Eyewear  Sora  Rimless  Sospiri  Riserva  SOUL  Robert Graham  Sperry's  Robert Marc  SPX  Roberto Cavalli  Spine  Robert Rudger  Spirit 2000  Rodenstock  Spy  Ronit Furst  Starck  Rough Justice  State  Roxy  Stepper  Rudy Project  Stetson  RVS  Steve Madden  S.Oliver  Stratus  Safety  Structure  Safilo  Studio 3  Safilo Kids  Style by Timex  Saks Fifth Avenue  Sunlites  Salt  Sun Trends  Salvatore Ferragamo  Superflex  Sama  Surface  Savvy  Swarovski  Scott Harris  Swissflex  Sean Bean  Swissflex Kids  Sean Jean  Switch  Sean John  TAG Heuer  See N' Be Seen  Takumi  Seiko  Tandy  Serafin  TapOut  Seraphina  Tartine et Chocolat  Serengeti  Team  Seventeen  Ted Baker  Shauns California  Teka   Teenage Mutant Ninja Turtles Sho Eyeworks 12  Thalia  Varg  Thema  Vari  Theo  Velvet  Theory  Vera Bradley  Thierry Mugler  Vera Wang  Tiffany and Co  Versace  Timberland  Versus  Timex  Via Roma  TITANFlex  Victory  TITANRimless  Vince Camuto  Titanos Collection  Vicious Vision  Titmus  Visions  Titmus Safety  Visualites  TMX  Viva  Todd Rogers  Vivid  Tom Davies  Vogue  Tom Ford  Von Arkel  Tomato  VonZipper  Tommy Bahama  Vuarnet  Tommy Hilfiger  Vue DC  Tom's  Waza  Tony Ferrara  Wildflower  Tony Hawk  Wiley X  Tory Burch  William Morris  Tory Burch Sunglasses  WK  Totally Rimless  Woolrich  Transformers  Woolverine  Tres Jolie  X-Games  Trevi Coliseum  Xavier Garcia  Trina Turk  XOXO  True Religion  XXL  Tumi  Yoshi  Tura Collection  Youpi  Turaflex  You's  Tuscany  Yves Saint Laurent  Twenty-Twenty  Zac Posen  Ultra Tech  Zeal  Urband  Zen  U-Turn  Zero G  Valentino  Z Eyewear  Valerie Spencer  Ziggy  Valmassoi ADDITIONAL FRAMES NEEDED:  Van Heusan  Other:______ Vanni  Other:______13  Other:______ Other:______