Lions Eyeglass Mobile Recycling Unit (LERMU) Equipment Reservation Question Title * 1. Club Contact Information Name Company Address Address 2 City/Town VA Virginia ZIP/Postal Code Country Email Address Phone Number OK Question Title * 2. Date of our club's recycling event Date / Time Date Time AM/PM - AM PM OK Question Title * 3. Pickup Date Pickup Date / Time Date Time AM/PM - AM PM OK Question Title * 4. Return Date/Time Date / Time Date Time AM/PM - AM PM OK Question Title * 5. Equipment Needed (please indicate 0 or the number of apparatus/supplies) Eyenetra Netrometer with Printers (2 available) Traditional TopCon Lensmeter (3 available) Recycling bags Recycling Boxe Shipping Boxes for 4 recycling boxes OK ALL SET! WE WILL BE IN TOUCH TO CONFIRM.