Request Authenticity50 PPE Masks
Manufactured by donations from citizens across the country, Authenticity50 is proud to be contributing 100,000 masks to help the PPE shortage.

If you work with or represent a healthcare facility that is assisting with frontline COVID-19 efforts and in dire need of masks for PPE, please fill out this form. Masks will be donated at no cost.

Due to the national level of this initiative, we are specifically looking to assist with large requests - 1,000 masks or more.

While it is our goal to fulfill as many requests as possible, masks are not guaranteed.
Contact Name (First & Last) *
Email Address *
Phone Number *
Hospital/Facility Name (Please Include City, State) *
Is your hospital a non-profit or for-profit facility? *
Department *
Shipping Address for Masks *
How many masks do you need? Please note we are seeking to donate to facilities with a need of at least 1,000 masks. *
Add a Note
Never submit passwords through Google Forms.
This form was created inside of Authenticity 50, LLC. Report Abuse