Chicago PPE Hospital and Medical Order Request
We supply three-layer 99% BPE melt-blown surgical-style masks in large quantities with short lead times to hospitals, assisted living facilities, COVID-19 crisis command centers. We are also making items available to support businesses and health care provides. Fill out this form to tell us about your needs and we will contact you as soon as possible.
Email address *
Disposable mask with elastic ear loops. 6 3/4 x 5 inches fully extended:
How many masks do you need? How frequently?
One Time
Per Month
Per Week
Other
50 to 1,000
2,500 to 10,000
100,000 to 500,000
1 million or more
Clear selection
What information will you need before placing an order?
What authorization do you have to place an order?
What other questions or comments do you have?
Your Name *
Your Title
Organization
Address Line 1 *
Address Line 2
City *
State *
Zip Code *
Best Phone number *
Can we text this number? *
What time zone are you in? When is the best time of day to call you? Can we call you in the evening or on weekends?
A copy of your responses will be emailed to the address you provided.
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