Arizona Together - Organization/Business Support & Donations
Arizona is committed to a unified effort to get our state through the COVID-19 outbreak. Please use the form below to let us know how your business or organization can help - either through donations, a food drive, or other activity.
Organization/Business Name *
Your answer
Organization/Business Website
Your answer
Organization Contact (First & Last Name) *
Your answer
Contact Phone Number *
Your answer
Contact Email Address *
Your answer
Select the county(ies) you operate in. *
Required
How is your organization interested in assisting Arizonans during the COVID-19 Outbreak?
Your answer
If your organization is offering the donation of goods or services to support COVID-19 relief efforts, please provide details about those good/services.
Your answer
For the donation of medical supplies or sanitation products please indicate each product type and quantity.
Your answer
Any additional information?
Your answer
By completing this form you are authorizing the State of Arizona to share your information with partner organizations in need of support. You may be contacted directly by the organization in need of support. Please check the box below to acknowledge this statement.
Submit
Never submit passwords through Google Forms.
This form was created inside of State of Arizona. Report Abuse