BK Optical USA, Inc.

1. Company Name

2. Your Name

3. Mail Address

4. City / State / Zip

5. Country

6. Phone / ext.

7. Fax

8. Email

9. Best Time To Contact

10. I am interested in:

11. Please Note End Use of the Frames. example: (sunglasses, safety eyeware, reading glasses)

12. Number of pieces (quantify)

13. Number Sizes Needed

14. List Colors Desired

15. Types of Hardware

16. Do you have a CAD file of frame? Yes No

17. Comments or Questions

Thank You for your interest in BK Optical USA Inc. One of our staff will contact you with in 2 - 3 working days.

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