Request Masks for your Facilities

Mask For Our Healthcare Heroes If you are a healthcare facility that needs masks, please fill out this form. Please let us know how many masks are needed. The name of the contact person and the address where they should be mailed or delivered for free.

Name*
First Last
Email*
Name of healthcare facility*
Address to deliver*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
How many phone numbers do you need?*
How the masks can be delivered to your facility (via mail, at a drop-off location, etc.)*
- Mail
- Drop-off
Which kind of mask do you prefer?*
- Simple 100% Cotton Mask
- 100% Cotton Mask with Filter Pocket
- Halyard Polypropylene
- Willing to take any kind
- Other:
How should the masks be secured? (Elastic is scarce)*
- Ties
- Elastic
- Either works
Which size do you need?*
- Medium
- Large
- Extra Large
How many do you need?
- 10
- 20
- 30
- 40
- 50
- 100
- 100
- Third Choice

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