Need masks?
Would you like to place a purchase order for fabric face masks or request to receive donations of fabric face masks? If so please fill out the form below and we will be in touch shortly:
Email *
Name of your organization *
Website of your organization *
Point of contact full name *
Point of contact phone number *
Organization’s shipping address *
Country you are located in: *
This may seem redundant but it helps us sort! :) With more and more volunteers - we want to match manufacturers locally to centers in need.
Would you like to submit request to purchase fabric masks or a request for a fabric mask donation? *
*Please note, purchased masks are made on-demand and invoices will be sent to the POC email address entered above. Donation requests are fulfilled as donated supplies, funds, and labor become available. The current wait times for donations are approximately 3 weeks or longer depending on the amount requested.
Do you have a preference of what type of mask you'd like to receive? *
Please note, tie masks are one-size fits all. For donations, we do our best to accommodate requests but supplies can be limited.
How many men’s masks are you requesting? *
How many women’s masks are you requesting? *
How soon do you need these masks? *
Please enter a date. If you can give us an understanding of when your org will need them we will try and prioritize based on need.
Do you also need gowns? If yes, how many?
Masks are our first priority but we have A LOT of manufacturers ready to help so please let us know if you need gowns and any requirements.
Anything else we should know? *
Please read and confirm: I understand these 100% cotton, double layer fabric face masks, derived from the Deaconess Hospital prototype, are NOT N95 or surgical grade face masks which provide particle protection. Prior to use, these face masks should be sanitized in hot water with detergent (sanitization setting on washing machine with bleach detergent if possible). *
Please read and confirm: For donations, I understand these masks are made by manufacturing facilities and volunteers across the US. The distribution of masks is managed by N.A.bld. *
Please read and confirm: I understand that these masks are not for resale. *
A copy of your responses will be emailed to the address you provided.
Clear form
Never submit passwords through Google Forms.
This form was created inside of Nineteenth Amendment.