Wyoming business PPE distribution request form
Wyoming has limited funds to provide distribution of personal protective equipment (PPE) to eligible businesses. Supplies may be distributed based on the size of the business. Due to current supply chain impacts, we do not have a firm date on when the PPE will be available. The Wyoming Office of Homeland Security is working with the Wyoming Business Council to provide these supplies to businesses. We are asking that you fill out the attached survey so that we may obtain an accurate count and schedule distribution. These efforts will help our Wyoming businesses with fulfilling needs that may assist them as we move forward in easing restrictions. This is on a first come / first serve basis as supplies are limited so we emphasize a timely response to this request.

We request that each business coordinate their response to ensure that only a single request is submitted per business.

We will contact the requester through email based on the order of request to give you instructions for your pickup location. Further instructions and contact information will be sent when PPE is available.

Please note that this is NOT a guaranteed distribution and you SHOULD NOT cancel any previous orders you may have placed through other sources. You may submit your request by clicking the Submit button at the bottom of the page or emailing an electronic copy to wohsppeinfo@wyo.gov. All communications and questions are also to be submitted through this email address wohsppeinfo@wyo.gov.

PLEASE SUBMIT RESPONSES BY 6/1/2020
Email address *
Business Name *
Your answer
Business Address *
Your answer
City *
Your answer
County *
Your answer
Zip Code *
Your answer
Type of Business *
***Non-profit organizations*** You may be eligible for Public Assistance Funding. Please email wohsppeinfo@wyo.gov
If "other" please describe your business
Your answer
Type of PPE *
Please choose from the following list of PPE. At this time, we will have the potential to supply the following PPE. (Supplies are not guaranteed.)
Required
Number of employees *
Supplies may be based on the number of employees you have identified (supplies are not guaranteed). Depending on supply you may get cloth/reusable masks or disposable masks. We WILL NOT be supplying N95 masks.
Requestor's Primary Contact Name *
Your answer
Requestor's Primary Contact Phone Number *
Your answer
Requestor's Primary Email Address *
Your answer
Please identify the individual(s) responsible for picking up your packages and their contact information.
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of State of Wyoming. Report Abuse