PNF - Products Need Form

Products Need Form should be completed by Clinical Directors & Program Staff Collaboratively!

Please keep in mind the following timeline requirements: ***US EVENTS: Submit PNF, 60 DAYS PRIOR to required DELIVERY DATE.

***NON-US EVENTS: Submit PNF 90 DAYS PRIOR to required DELIVERY DATE.

****** ALL EE FRAME REQUEST HAVE A STRICT 90 DAY SUBMISSION REQUIREMENT FOR GUARANTEE DELIVERY ********

CONTACT INFORMATION

OE Director Name*

OE Director Email*

SO Program Email address*

Send an automatic copy of this form to SO Program Health Rep.

Funding Status*

Select

EVENT INFORMATION

Event Start Date*

Screening Days*

How many days will your event take place

How many vision screenings do you expect at this event*

Sporting Event*

Select all that apply

Select

State*

Select

City*

Country*

Select

Region*

Select

SHIPPING INFORMATION

SO Program Email*

Ship to NAME*

Ship to ADDRESS*

Ship to CITY*

Ship to STATE*

Ship to Zip/Postal Code*

Ship to COUNTRY*

Select

Ship to Notes

Ship to Phone #*

Ship to EMAIL*

Ship to 2nd EMAIL

Charity (Tax) Number*

EORI #/Tax ID Required for shipping supplies to EE programs.

If not applicable, please write N/A

Custom Instructions

ALL EUROPEAN COUNTRIES MUST PROVIDE THEIR EORI NUMBER/TAX ID FOR IMPORTS & EXPORTS FOR CUSTOMS CLEARANCE.

Please be prepared to receive all shipments promptly. Have appropriate customs documents, tax ID# etc. required for your country. List any specific shipping requirements i.e., quantities, $ amount, etc. that is revelent for your country or territory. Prepare for taxes/duties fees.

SUPPLY QUANTITIES

Frames - Adult Male

Frames- Adult Female

Frames- Children (eyesize 32-48)

Children sizes range from 32/48 mm eyesizes. When requesting frames for "teens" or small adult sizes please order under male/female/adult and be specific to quantity of small adult male/female sizes in special request.

Sunglasses - Male PLANO

Sunglasses - Female PLANO

Sunglasses - Children PLANO

Eyeglass Cases*

Select an option if you need to order cases. you may select both small and large cases.

Select or enter value

How many small cases do you need?

How many large cases do you need?

Any special requests?

Please be specific about sizes, materials, and colors preferences.

Rx Sport Goggles

OUT OF STOCK/UNAVAILABLE

Swim Goggles - Rx Only

*Not fabricated through Essilor Portal

Slit Lamp

Autorefractor

iCare Tonometer

iCare Probes (100/box)

Phoropter Stands

Photopter Stands arrive with a combination lock, please use 621 to unlock and return locked with the same lock for safe shipping.

Distance Lea Chart

Near Lea Chart

Stereo Chart

Color Vision Chart

OUT OF STOCK; Color Vision Test will not be required Q4 2024

OE Program Banner

T-Shirt Quantities

All volunteers, including CDs are required wear a proper OE branded T-Shirt. Please let us know below your T-shirt needs for this event.

T-Shirt Small

T-Shirt Medium

T-Shirt Large

T-Shirt XL

T-Shirt 2XL

T-Shirt 3XL

T-Shirt 4XL

Low inventory

Eyeglass Straps (Croakies)

US events only, max. 200 per event

PNF COMPLETED BY;*

Contact Santinelli or Essilor Instruments for support. List available upon request

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