Face Shield Order Requests
Please fill out the following form and Polymershapes will contact you to complete the process. Polymershapes Business Hours are:
    8-6 PM — Mon-Fri
    May take 1-2 business days to confirm order details per transaction.

MIT is providing the design at no cost to verified professional die cutters with contractual language that constrains price gouging.

Sign in to Google to save your progress. Learn more
Requester Contact Information
Company / Health Care Organization Name *
Contact Name *
Contact Phone Number *
Contact Email *
Contact Job Title *
Order Information
Once submitted, a Polymershapes representative will contact you during our normal business hours of 8:00 am - 6:00 pm Eastern Time to confirm your order information and obtain payment.
Number of Cases (125 Shields/Case) *
YOU ARE ORDERING BY THE CASE. Please note that the number you enter below is the number of CASES you would like to order. Each case has 125 shields in it.
Billing Information
Bill to Street Address *
Bill to Suite/Bldg Number
City *
State *
Zip Code *
Shipping Information
Ship to Street Address *
Ship to Suite/Bldg Number
City *
State *
Zip Code *
Payment Process
Payment Type *
A business sales associate from Polymershapes will contact you shortly to confirm order and payment details.
Freight Terms *
If Carrier Freight, Carrier Name and Account Number
Next Steps
Completing this form it is not a confirmation or guarantee. Your Polymershapes representative will confirm your order once we have contacted you, and collected the necessary additional information. In the meantime, if you need to, you can reach us at 1-844-650-7700.
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of MIT Google Apps. Report Abuse