AR COVID-19 Medical Supply Availability & Needs Website Publishing
Please complete this form if you have any medical supplies to sell, donate, or purchase in the state of Arkansas. This will be included in our website for public viewing. By completing this form, you consent to publish all the information provided.
Company Name (If Applicable)
Contact Person *
Contact Phone Number
Contact Email *
Confirm Contact Email *
Medical Supplies for Sale, List All Available (for Arkansas Only)
Medical Supplies to Donate, List All Available (for Arkansas Only)
Medical Supplies Needed, List All Necessary (for Arkansas Only)
Additional Description and/or Comments (If Needed)
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy