Hand Sanitizer Donation Request Form
We are continuing with our donations to those on the frontline facing COVID-19. If your entity is unable to purchase product and would like to be considered for our donation program please fill out this form.
If you are interested in requesting at least 500 bottles for PUBLIC distribution at a reduced price, please complete our Partner for My Community Drive Form at this link:
If you would like to purchase in bulk, pallet quantities, please fill out our Bulk Order Form at this link:
If you would like to direct purchase sanitizer, please do so at this link:
We have set up an online store that we will update regularly based on current availability. Each purchase has a specific pickup date and time. Please make arrangements to pick up during these parameters or risk your order being returned to inventory.
What type of facility do you represent?
In Home Care
How many people do you want to provide this product in your facility? Please enter a numerical value only.
How many 3 oz bottles would you like to request?
If a bulk amount would be more efficient, how many gallons would you like to request?
Name of your organization
Your zip code (At this time, we are not shipping this product. Someone from your team will have to pick it up in Dodge City, KS.)
I understand this is a donation form. Please Visit
for more information.
Pending pick up date confirmation. I, or someone from my team, will pick this product up at 501 W Spruce St. in Dodge City, KS. Please park in front of the "Office of the Marshal" door off of the North parking lot and ring the doorbell.
What do we need to know about the importance of your request?
Send me a copy of my responses.
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This form was created inside of Boot Hill Distillery.