Fabric Face Masks Needed Request Form

*Your name:

Please enter your name.

*Your email:

Please enter your email address.Enter a valid email address.

*Your phone number:

Please enter your phone number.

Name of Facility:

Contact person, if available:

Street Address:

City, State, Zip:

Website:

Drop-off Info:

Can donation be mailed:

Yes - Where
No

Fabric mask style or Pattern:

Elastic behind ears
Elastic over head
Ties
Any well-made mask

Material:

100% Cotton
Polypropylene
Other

Surgical/Scrub Caps:
Approximate number needed:

Yes No

* Please select the current month from the drop-down so we know you are not a spambot.

Please select a month.Please select a month.

Please check this box to confirm that you understand that items sent to you are being made by various volunteers and skill level will vary; and that your facility will inspect the items and use only as appropriate. Please note that while we are making every effort to connect people who sew with places of need, we made no guaranty of quantity or quality of what you may receive. Please check to agree.