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Impact: How You Can Help
Mission Inquiry Form
Please fill out the form below to:
Request eyeglasses for an overseas vision mission
Follow-up on a previous request for eyeglasses
A representative from New Eyes will contact you to follow up on your request.
Mission Name*
Contact Person*
Day Telephone #*
Email Address*
Web Site Address*
Please tell us about your organization: who it helps, the countries you serve, etc.*
Your complete Mailing Address: *
Would your organization be willing to pay for the cost of shipping?*
What type and quantity of eyeglasses
would you like ?(click on all that are appropriate)*
Untested Single Vision Glasses
#
Tested single Vision Glasses
Untested Bifocals
#
Tested Bifocals
#
Non-prescription sunglasses
#
Kids' glasses/Sunglasses
#
Pairs of lenses
#
Empty frames
#
Demonstration glasses
#
Eyeglass cases
#
Sports glasses
#
Eyeglasses with astigmatism
#
Reading Glasses 100-175+
#
Reading Glasses 200-275+
#
Reading Glasses 300+
#
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