Mask Request Form | @maskbloc614 Linktree

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Mask Request Form | @maskbloc614 Linktree

PLEASE READ THIS SECTION BEFORE FILLING OUT THE FORM:

Fill out the following form to request FREE masks from mask bloc 614!
We offer pickup and delivery for the Columbus, Ohio area.

Regarding requests being made for organizations, groups, and events throughout Ohio: We ask that you please direct message us via Instagram or Twitter rather than filling out this form, thank you.

Allow for at least 3-5 days for processing and delivery/pickup. We will likely not be able to fulfill requests with less notice than that.

We delete all addresses once the drop-off requests are fulfilled, and all are welcome to direct us to delete their request after it is fulfilled as well.

Email us at maskbloc614@protonmail.com or send us a direct message on Instagram @maskbloc614 (clickable link) or Twitter @maskbloc614 (clickable link) for any additional inquiries!

Are you located in central Ohio?
*

If not, please check out the COVID advocacy map (clickable link) to see if there are mask mutual aid projects closer to you, or direct message us on Instagram or Twitter (@maskbloc614) so we can help you look.
If you are located outside of central Ohio, we may be able to mail to you, but we have a limited capacity to do so.

Yes

Email Address or Phone Number

Please provide the email address or the phone number that you would like us to use to contact you.

Who is this request for?
*

Individual/Family/Household

Business

How many people need masks?
*

Type(s) of mask requested
*

Any / No preference

Sample bag (variety of types)

Head Strap (N95, white, 3M Aura 9205+)

Head Strap (N95, white, 3M Aura 9210+)

Head Strap (N95, white, 3M VFlex 1804S, small)

Head Strap (N95, light blue, ACI 3120)

Headstrap (N95, white, Jackson Safety R10)

Headstraps (N95, white, Blox Surgical N95)

Headstrap (N95, turquoise, 3M 1860S, small)

Ear Loops (KN95, white, 3M 9501+)

Strapless (N95, yellow adhesive, MRI safe, Alliant BioTech)

Other:

Required

If applicable, please specify how many people need each type of mask

(For example, if you're requesting for your household, please let us know which mask type[s] each individual needs. If you're unsure, we're happy to provide a variety for all as well)

Pick Up or Drop Off
*

Pick up

Drop off (don't forget to give us your address below)

Address for drop off (if applicable)

Please be sure to include all necessary information.
For example, if the drop off location is a front desk or mailroom, then please include any name, apartment number, dorm number, etc. that might be needed for our delivery to be accepted.

Questions / Comments / Access Needs / Security Needs

Storefront Cooperation?

If you run a storefront, or you are part of an organization that wants to provide resources for community care, would you be open to keeping some space for allowing us to set up a shelf where people can access free masks at no cost to you?
If so, please leave your storefront / organization name below, along with an email address to reach you at! Thank you.

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms