Order Form, Safety Glasses

Fax orders:  Print order form and fax with credit card and shipping information filled in.
Mail orders:  Print order form and mail with your check.
Phone orders:  Print or view order form and call Elvex at 800-888-6582. Have credit card ready (Visa and MasterCard only).

Industrial/Institutional prices may be lower. Contact your local safety equipment distributor for pricing information. Elvex will be pleased to provide name and addresses of a distributor in your area, when available.

Prod. #

Product Name and Description

Unit Price

Quantity Ordered Total Cost
RX-100 Bifocal Reading Safety Glasses, clear lens, Specify diopter 1.0, 1.5, 2.0, 2.5 or 3.0.  (Fill in diopter:___________) $15.90

ea.

$
RX-100G Bifocal Reading Safety Glasses, gray sun glare lens, specify diopter 1.0, 1.5, 2.0, 2.5 or 3.0,  (Fill in diopter:___________) $15.90

ea.

$
RX-200 Bifocal Reading Safety Glasses, clear lens, Specify diopter 1.0, 1.5, 2.0, 2.5 or 3.0.  (Fill in diopter:___________) $12.60

ea.

$
RX-200G Bifocal Reading Safety Glasses, gray sun glare lens, specify diopter 1.0, 1.5, 2.0, 2.5 or 3.0,  (Fill in diopter:___________) $12.60

ea.

$
RX-300 Bifocal Reading Safety Glasses, clear lens, Specify diopter 1.0, 1.5, 2.0, 2.5 or 3.0.  (Fill in diopter:___________) $10.20 ea. $
RX-300G Bifocal Reading Safety Glasses, gray sun glare lens, specify diopter 1.0, 1.5, 2.0, 2.5 or 3.0,  (Fill in diopter:___________) $10.20 ea. $
RX-400 Bifocal Reading Safety Glasses, clear lens, Specify diopter 1.0, 1.5, 2.0, 2.5 or 3.0.  (Fill in diopter:___________) $7.90 ea. $
RX-400G Bifocal Reading Safety Glasses, gray sun glare lens, specify diopter 1.0, 1.5, 2.0, 2.5 or 3.0,  (Fill in diopter:___________) $7.90 ea. $
SG-10C Ranger, clear uncoated Polycarbonate lens $2.40

ea.

$
SG-10A Ranger, amber uncoated Polycarbonate lens $2.60 ea. $
SG-10G Ranger, gray uncoated Polycarbonate lens $2.60 ea. $
SG-12C Acer, clear hard coated Polycarbonate lens $4.40 ea. $
SG-12C-AF Acer, clear anti-fog coated Polycarbonate lens $5.30 ea. $
SG12A Acer, amber hard coated Polycarbonate lens $4.60 ea. $
SG-12 I/O Acer, Indoor/Outdoor hard coated Polycarbonate lens $5.30 ea. $
SG-12G Acer, gray hard coated Polycarbonate lens $4.60 ea. $
SG-12G-AF Acer, gray anti-fog coated Polycarbonate lens $5.50 ea. $
SG-12M Acer, silver mirror coated Polycarbonate lens $5.30 ea. $
SG-13C TNT, clear hard coated Polycarbonate lens $2.40 ea. $
SG-13C-AF TNT, clear SuperCoat anti-fog Polycarbonate lens $3.00 ea. $
SG-13B TNT, ice blue hard coated Polycarbonate lens $2.60 ea. $
SG-13 I/O TNT, Indoor/Outdoor hard coated Polycarbonate lens $2.90 ea. $
SG-13G TNT, gray hard coated Polycarbonate lens $2.60 ea. $
SG-13M TNT, flash mirror coated Polycarbonate lens $2.90 ea. $
SG-14C Xenon, clear hard coated Polycarbonate lens $2.80 ea. $
SG-14C-AF Xenon, clear SuperCoat anti-fog Polycarbonate lens $3.50 ea. $
SG-14B Xenon, ice blue hard coated Polycarbonate lens $3.00 ea. $
SG-14 I/O Xenon, Indoor/Outdoor hard coated Polycarbonate lens $3.50 ea. $
SG-14G Xenon, grey hard coated Polycarbonate lens $3.00 ea. $
SG-14G-AF Xenon, grey anti-fog coated Polycarbonate lens $3.90 ea. $
SG-14M Xenon, silver mirror hard coated Polycarbonate lens $3.50 ea. $
SG-15C TTS, clear hard coated Polycarbonate lens $2.25 ea. $
SG-15C-small TTS, Small, clear hard coated Polycarbonate lens $2.80 ea. $
SG-15C-AF TTS, clear SuperCoat anti-fog Polycarbonate lens $2.90 ea. $
SG-15A TTS, amber hard coated Polycarbonate lens $2.70 ea. $
SG-15G TTS, gray hard coated Polycarbonate lens $2.70 ea. $
SG-15-I/O TTS, Indoor/Outdoor hard coated Polycarbonate lens $3.00 ea. $
SG-15M TTS, mirror hard coated Polycarbonate lens $3.00 ea. $
SG-17C Trix, clear hard coated Polycarbonate lens $2.90 ea. $
SG-17C-AF Trix, clear SuperCoat anti-fog Polycarbonate lens $3.60 ea. $
SG-17G Trix, clear hard coated Polycarbonate lens $3.00 ea. $
SG-17 I/O Trix, indoor/outdoor hard coated Polycarbonate lens $3.40 ea. $
SG-17M Trix, mirror hard coated Polycarbonate lens $3.60 ea. $
SG-20C UniWraps, clear hard coated Polycarbonate lens $6.75 ea. $
SG-20C-AF UniWraps, clear SuperCoat anti-fog coated Polycarbonate lens $8.00 ea. $
SG-20A UniWraps, amber hard coated Polycarbonate lens $7.00 ea. $
SG-20G UniWraps, gray hard coated Polycarbonate lens $7.00 ea. $
SG-20-I/O UniWraps, Indoor/Outdoor hard coated Polycarbonate lens $7.85 ea. $
SG-20M UniWraps, Gold mirror coated Polycarbonate lens $7.40 ea. $
SG-23C Challenger S (small), clear hard coated Polycarbonate lens $4.50

ea.

$
SG-23G Challenger S (small), gray hard coated Polycarbonate lens $4.75 ea. $
SG-24C XTS, clear hard coated Polycarbonate lens $5.50 ea. $
SG-24AG XTS, anti-glare hard coated Polycarbonate lens $5.70 ea. $
SG-24 I/O XTS, Indoor/Outdoor hard coated Polycarbonate lens $6.00 ea. $
SG-24G XTS, gray hard coated Polycarbonate lens $5.70 ea. $
SG-24M XTS, Silver mirror coated Polycarbonate lens $6.00 ea. $
SG-25C Challenger, clear hard coated Polycarbonate lens, black frame $2.50 ea. $
SG-25C Challenger, clear hard coated PC lens, All-American frame $2.50 ea. $
SG-25C-AF Challenger, clear SuperCoat anti-fog PC lens, Specify All-American or black frame $3.25 ea. $
SG-25G Challenger, gray hard coated Polycarbonate lens, black frame $2.70 ea. $
SG-25G Challenger, gray hard coated PC lens, All-American frame $2.70 ea. $
SG-25WS3 Challenger, welding shade 3, hard coated Polycarbonate lens $7.30 ea. $
SG-25WS5 Challenger, welding shade 5, hard coated Polycarbonate lens $7.30 ea. $
SG-27C OVR-Specs (Over-the-glasses-specs), clear PC lens $6.75 ea. $
SG-28C Summit, clear hard coated Polycarbonate lens $4.80 ea. $
SG-28C-AF Summit, clear anti-fog coated Polycarbonate lens $5.75 ea. $
SG-28 I/O Summit, Indoor/Outdoor hard coated Polycarbonate lens $5.75 ea. $
SG-28G Summit, gray hard coated Polycarbonate lens $5.00 ea. $
SG-28M Summit, silver mirror hard coated Polycarbonate lens $5.75 ea. $
SG-29C Summit II, clear hard coated Polycarbonate lens $4.95 ea. $
SG-29C-AF Summit II, SuperCoat anti-fog coated Polycarbonate lens $5.60 ea. $
SG-29 I/O Summit II, Indoor/Outdoor hard coated Polycarbonate lens $5.75 ea. $
SG-29G Summit II, gray hard coated Polycarbonate lens $5.20 ea. $
SG-29M Summit II, silver mirror hard coated Polycarbonate lens $5.75 ea. $
SG-30C Neutron, clear hard coated Polycarbonate lens $4.60 ea. $
SG-30C-AF Neutron, clear anti-fog coated Polycarbonate lens $5.50 ea. $
SG-30 I/O Neutron, indoor/outdoor hard coated Polycarbonate lens $5.75 ea. $
SG-30G Neutron, gray hard coated Polycarbonate lens $4.80 ea. $
SG-30M Neutron, silver mirror coated Polycarbonate lens $5.75 ea. $
SG-32C Sphere-X, clear hard coated Polycarbonate lens $4.15 ea. $
SG-32C-AF Sphere-X, clear SuperCoat anti-fog coated Polycarbonate lens $5.00 ea. $
SG-32A Sphere-X, amber (yellow) hard coated Polycarbonate lens $4.40 ea. $
SG-32G Sphere-X, gray hard coated Polycarbonate lens $4.40 ea. $
SG-32G-AF Sphere-X, gray SuperCoat anti-fog coated Polycarbonate lens $5.30 ea. $
SG-32 I/O Sphere-X, indoor/outdoor hard coated Polycarbonate lens $5.50 ea. $
SG-32M Sphere-X, mirror hard coated Polycarbonate lens $5.50 ea. $
SG-34C-blue Axiom, clear hard coated PC lens, electric blue frame $5.20 ea. $
SG-34C-gray Axiom, clear hard coated PC lens, metallic gray frame $5.20 ea. $
SG-34G-blue Axiom, gray hard coated PC lens, electric blue frame $5.40 ea. $
SG-34G-gray Axiom, gray hard coated PC lens, metallic gray frame $5.40 ea. $
SG-34 I/O-blue Axiom, Indoor/Outdoor hard coated PC lens, electric blue frame $6.10 ea. $
SG-34 I/O-gray Axiom, Indoor/Outdoor hard coated PC lens, metallic gray frame $6.10 ea. $
SG-35C Triad, clear hard coated Polycarbonate lens $4.95 ea. $
SG-35G Triad, gray hard coated Polycarbonate lens $5.20 ea. $
SG-35 I/O Triad, Indoor/Outdoor hard coated Polycarbonate lens $5.60 ea. $
SG-35M Triad, Silver mirror hard coated Polycarbonate lens $5.60 ea. $
SG-35PL Triad, Polarized Polycarbonate lens    New!! $31.50 ea. $
SG-36C Orbit, clear hard coated Polycarbonate lens $4.95 ea. $
SG-36 I/O Orbit, Indoor/Outdoor hard coated Polycarbonate lens $6.10 ea. $
SG-36G Orbit, gray hard coated Polycarbonate lens $5.50 ea. $
SG-36M Orbit, blue mirror coated Polycarbonate lens $6.30 ea. $
SG-40C Alloy, clear hard coated Polycarbonate lenses $7.00 ea. $
SG-40 I/O Alloy, Indoor/Outdoor  hard coated Polycarbonate lenses $7.65 ea. $
SG-40G Alloy, grey hard coated Polycarbonate lenses $7.20 ea. $
SG-200C-grey Elite, clear hard coated Polycarbonate lenses, transparent grey frame $4.95 ea. $
SG-200C-blue Elite, clear hard coated Polycarbonate lenses, transparent blue frame $4.95 ea. $
SG-200G Elite, gray hard coated Polycarbonate lenses $5.40 ea. $
SG-200 I/O Elite, Indoor/Outdoor hard coated Polycarbonate lenses $5.60 ea. $
SG-400C Atom, clear hard coated Polycarbonate lens $2.95 ea. $
SG-400C-AF Atom, anti-fog coated Polycarbonate lens $3.80 ea. $
SG-400B Atom, ice blue hard coated Polycarbonate lens $3.15 ea. $
SG-400 I/O Atom, indoor/outdoor hard coated Polycarbonate lens $3.60 ea. $
SG-400G Atom, gray hard coated Polycarbonate lens $3.15 ea. $
SG-400M Atom, silver mirror hard coated Polycarbonate lens $3.60 ea. $
SGB-5 Micro Fiber Protective Bag $1.20 ea. $
SGB-10 Small Neoprene Safety Glass Bag, with belt hook $4.00 ea. $
SGB-20 Large Safety Glass Bag, with belt loop and belt hook $5.00 ea. $
SGB-30 Protective micro-fiber bag for goggles $4.00 ea. $
GG-25C-AF-gray Legionnaire, clear SuperCoat anti-fog lens, smoke body $4.80 ea. $
GG-25C-AF-blue Legionnaire, clear SuperCoat anti-fog lens, blue  body $4.80 ea. $
GG-25C-AF-AS-gray Legionnaire, clear SuperCoat anti-fog lens, wide strap, smoke body $5.90 ea. $
GG-30-AF Visionaire Goggles with SuperCoat anti-fog Polycarbonate lens, woven elastic strap $8.60 ea. $
GG-30G-AF Visionaire Goggles with gray SuperCoat anti-fog Polycarbonate lens, woven elastic strap $9.00 ea. $
GG-32-AF Visionaire Goggles with SuperCoat anti-fog Polycarbonate lens, neoprene rubber strap $9.00

ea.

$
GG-35-AF Visionaire Goggles with dual lens, inside SuperCoat anti-fog Acetate lens/outside Polycarbonate $16.25

ea.

$
. . . . .
. . . . .

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SUBTOTAL --- --- $

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CT Sales Tax, 6% (CT residents only) --- --- $

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Shipping and Handling --- --- $

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TOTAL ORDER --- --- $

Ship to:

Name, Title  
Company/Other Information  
Address  
City, State, Zip  
Phone  

 Credit card:   VISA  (     )    MasterCard (     )

Credit card number:   ______________________

Credit card Expiration:  ____________________

Billing address, if different from above:

______________________________________

______________________________________

Order Information:
Please include payment with your order. Add shipping  costs in accordance with shipping cost table to the right.

 

Shipping Charges for USA:

  • Minimum order is $30.00
  • For orders below $100.00 add $9.00 for shipping and handling
  • For orders between $100.00 and 250.00 add 9% for shipping and handling
  • For orders exceeding $250.00 add 7% for shipping and handling
International and express shipping orders:
Please inquire by fax or email.
Elvex Corporation, 13 Trowbridge Drive, P.O. Box 850, Bethel, CT 06801, USA
Phone: 800-888-6582, 203-743-2488, Fax: 203-791-2278, E-mail: info@elvex.com

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