Replacement Shield (Clear Plastic) Order Form
If you are in need of more shields (clear plastic parts), we have still hundreds and would love to get some to you! We will email you when and where to pick them up. Most orders will be ready within a couple days of when you place them. If you have any questions, please email

NOTE: This form is for clear plastic shield parts only, not the visor headband. If you need complete face shields (headband and shield), fill out this form instead:
Email address *
Contact Name (First Last) *
Contact Phone Number *
Are you able to pick up your order from Mounds View, MN? (address will be sent when your order is ready for privacy reasons) *
Delivery Address (we prefer that you pick up if possible, but if you can't we will deliver or look into shipping it for you)
Description of where shields will be used (e.g. ICU, general clinic, nursing home, retail, personal, etc.)
Minimum number of shield plastic you need *
Maximum number of shield plastic (one per staff member please - shields can be disinfected and reused) *
Other comments
A copy of your responses will be emailed to the address you provided.
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