SBBC Mask Distribution Request
These medical masks are made in China, which are certified by the Chinese government although not FDA-certified.
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Pickup or Delivery (Please choose one)
Pickup from the West San Jose location (Gene, 1140 Queen Anne Drive, San Jose)
Pickup from the Almaden location (Stephen, 745 Almondwood Way, San Jose)
Pickup from the Dublin location (Sebastian, 7155 Tamarack Drive, Dublin)
Deliver to recipient address
Who are these masks for?
Immediate family (20 masks per household)
Children (10 small size masks per household, only available in West San Jose location)
Friends (20 masks per household)
Neighbors (20 masks per household)
Essential service provider (40 masks)
Essential service provider (80 masks)
Essential service provider (120 masks)
Exceptional case (500 masks, with evidence of critical need)
If this is for an essential service provider or exceptional case, please write the name of the service or give a short description. (Write N/A if otherwise)
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This form was created inside of South Bay Bible Church.