Constituent PPE Request Form
Please fill out this form if you would like to pick up some PPE from our office. Constituent pick ups will be Mondays and Fridays from 2 PM to 5 PM at 1077 Nostrand Avenue (Between Lefferts Avenue & Lincoln Road). Please note that supplies are limited.
Email address *
First Name *
Your answer
Last Name *
Your answer
Address *
Your answer
I would to get *
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