Enclosure (1) to COMDTINST 6490.1A
INSTRUCTIONS FOR COMPLETING CONTEMPORARY EYEWEAR ORDERING FORM
JOB NUMBER: Leave blank.
CUSTOMER'S TRAY NUMBER: Leave blank.
ARRIVAL DATE: Leave blank.
TRAY NUMBER: Leave blank.
CUSTOMER: Enter "Commandant (G-KRM-1), USCG Headquarters."
CITY, STATE, ZIP: Enter "Washington, DC 20593-0001."
COST BREAKDOWN-LENSES: Enter the cost of the lenses as listed in the catalog.
FRAME: Enter the cost of the frame as listed in the catalog.
EXTRA: Enter the cost of the tint or other options, if any, along with price as listed in the catalog.
Space is provided for two extra cost items.
CASE: Enter the cost of the safety carrying case (optional) as listed in the catalog.
TOTAL: Add the cost of the lenses, frame, all extra items, and case. Subtract .00 for single
vision prescriptions or .00 for bifocal or trifocal prescriptions from the total, and place the
new total in the SPECIAL INSTRUCTIONS section. The total in the SPECIAL
INSTRUCTIONS section is the amount that you will have to enclose with your ordering
form.
Note: You must enclose a postal money order with the correct amount.
PATIENT INFORMATION: Print your Rank/Rate, full name, and complete work telephone
number, including area code.
SHIP TO ADDRESS: Print the address of where you would like the eyewear sent.
PRESCRIPTION INFORMATION: Ask a Health Services Technician or contract provider to fill
all sections regarding prescription information, beginning with SPHERE and ending with
TEMPLE LENGTH AND STYLE.
SPECIAL INSTRUCTIONS: Print "TOTAL PAID BY MEMBER - (and dollar amount)" and
print "MONEY ORDER ATTACHED."
Keep the customer's copy for your receipt.