LENS REPLACEMENT FORM.
Complete and Return With Frames To Be Traced For New Lenses.

I. ACCEPT TERMS

I,(print name) , am sending the enclosed sunglasses for inspection, and if possible repair subject to the charges and terms stated on this form.

Signature REQUIRED: Email REQUIRED:

Sunglasses We Cannot Repair: Upon inspection, we may find that your sunglasses do not fit our equipment, or are of too poor quality to repair. There is NO charge for inspection, but sunglasses that cannot be repaired will be returned to you ONLY if you select this option in the "Return Shipping" section below.

Returns/Exchanges Not Allowed: Charges for repairs are non-refundable once service is rendered. For compensation in the event of lost or damaged sunglasses see below.

Lost/Damaged Sunglasses: Compensation for materials lost or damaged in our care or return shipping is limited to a refund of repair charges.

WE ARE NOT RESPONSIBLE FOR SUNGLASSES LOST OR DAMAGED DURING SHIPMENT TO US!

II. BILLING / SHIPPING

Billing Address:

Shipping Address:

Payment:

Credit Card Number:

Expiration Date:

III. LENS SELECTION (Priced per Pair)

Silica Glass Polarized

Copper Polarized Glass $40

Polycarbonate Polarized

Tan Polarized Poly $25
Blue Mirror Grey Polarized Poly $25

IV. SHIPPING IS $6.95 (USPS Priority Mail 2-3 Days)

You must check the box below to have sunglasses that cannot be repaired returned to you.
Bill me only $8.95 and return my sunglasses if they cannot be repaired.

V. SEND COMPLETED FORM & PRODUCT FOR REPAIR TO:

Acies Inc / Greatshades.com, 1161 McCabe Ave., Elk Grove, IL 60007