Are you in need of donated COVID-19 supplies?
Please fill this form out if you need donated supplies. Email
MaskAHeroNY@gmail.com
if you have questions. Thank you!
Sign in to Google
to save your progress.
Learn more
* Required
Email
*
Your email
Name
*
Your answer
Phone Number
Your answer
Name of Hospital/Facility and Department
*
Your answer
Details of supplies you need
*
Your answer
What quantity of those supplies do you need?
*
Your answer
Can you pick the supplies up?
*
Yes
No
Other:
If you can pick them up, in what areas can you do a pickup?
Your address will not be shared until we've made a match and someone has gotten in contact with you.
Your answer
Can people ship the supplies to you?
*
Yes
No
Other:
If the supplies can be shipped, what is your shipping address?
Your answer
Do you agree to these terms?
*
THIS WEBSITE IS RUN ENTIRELY BY VOLUNTEERS. THE INTENT OF THE WEBSITE IS TO CONNECT DONORS WITH RECIPIENTS, AND IS FOR INFORMATIONAL PURPOSES ONLY. WE DO NOT, AND WE HAVE NO OBLIGATION TO, REVIEW OR VET OUR DONORS, OUR RECIPIENTS, OR ANY MATERIALS OR INFORMATION PROVIDED BY THE DONORS OR RECIPIENTS, OR TO VERIFY THE QUALITY OR APPROPRIATENESS OF THE EQUIPMENT OR SUPPLIES BEING OFFERED FOR DONATION.THE WEBSITE, ALL INFORMATION THEREON, AND THE SERVICES ARE PROVIDED “AS IS” AND “AS AVAILABLE.” WE HEREBY DISCLAIM ALL REPRESENTATIONS AND WARRANTIES, EXPRESS, IMPLIED, AND STATUTORY, IN CONNECTION WITH THE WEBSITE, ANY INFORMATION CONTAINED HEREIN, THE DONORS AND RECIPIENTS USING THE WEBSITE, AND ALL EQUIPMENT AND SUPPLIED OFFERED THROUGH THE WEBSITE, INCLUDING WITHOUT LIMITATION, WARRANTIES OF NON-INFRINGEMENT, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, AND ANY WARRANTIES ARISING FROM A COURSE OF DEALING, COURSE OF PERFORMANCE, OR USAGE OF TRADE. WITHOUT LIMITING THE GENERALITY OF THE FOREGOING, WE HEREBY DISCLAIM ANY AND ALL RESPONSIBILITY OR LIABILITY FOR THE SAFETY, ADEQUACY, APPROPRIATENESS, OR AVAILABILITY OF ANY EQUIPMENT OR SUPPLIES OFFERED THROUGH THE WEBSITE, OR THE ACCURACY OR RELIABILITY OF THE INFORMATION AND CONTENT CONTAINED ON THE WEBSITE. RATHER THAN RELYING ON THIS INFORMATION, YOU SHOULD CONDUCT YOUR OWN RESEARCH AND DUE DILIGENCE ON ANY DONOR, RECIPIENT, EQUIPMENT, SUPPLIES, AND INFORMATION. YOUR USE OF THE WEBSITE, TRANSACTIONS WITH ANY DONORS OR RECIPIENTS, AND ACCEPTANCE OR USE OF ANY DONATIONS IS AT YOUR OWN RISK.THIS WEBSITE IS NOT INTENDED, AND SHALL NOT BE CONSTRUED, TO PROVIDE ANY TYPE OF FINANCIAL, TAX, MEDICAL, LEGAL, OR OTHER PROFESSIONAL ADVICE OR SERVICES. YOU SHOULD CONSULT WITH YOUR OWN PROFESSIONAL ADVISORS. WE DO NOT ADVISE ON THE TAX CONSEQUENCES OF ANY DONATION.
Yes
Required
Send me a copy of my responses.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This form was created inside of Mattweinberg.net.
Report Abuse
Forms
