3D Printed Face Shields Donation Request Form
This form is used to facilitate PPE (3D printed face shield) donation requests from Medical Facilities and Medical Professionals in greater Cincinnati /Tristate area.
Please contact us at faceshields4frontline@gmail.com for questions.
Contact Name *
Contact Title *
Contact Email Address *
Contact Department *
Contact Phone Number *
Medical Facility, Clinic, Organization requesting 3D printed face shields donation *
Facility /Clinic /Organization address (primary site location) where 3D printed face shields will be used *
Total Face Shields Quantity Requested *
Requested Delivery Date *
MM
/
DD
/
YYYY
Delivery /Pick Up Options *
If you choose pick up option, we will provide further directions via email.
If you chose Deliver to Your Location Option, provide your delivery address and instructions
Additional Comments (if applicable)
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