PPE + Reopening Supplies Marketplace Intake Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Welcome to the intake form for the PPE + Reopening Supplies Marketplace. The City of New York is providing this list of suppliers to offer a one-stop shop to feature products that can aid in the re-opening efforts of our business community. After successfully completing this form and confirming that your product is aligned to local (non-medical) business needs, your information will be added to a public online registry for companies in need of PPE and re-opening supplies/products. Please allow up to 3-4 days to see your information listed on the registry if your products meet the criteria.

Note that there are different sections for each of the following types of products: (i) face masks and coverings, (ii) face shields, (iii) gloves, (iv) cleaning and disinfectant products, (v) physical enhancements and portable furniture, and (vi) Other (e.g. goggles, thermometers). Please fill out all the sections that apply to your business.

What is your business name? *

What is the contact name for making any purchases? *

What is the number to call for making purchases? *

What is the email for making purchases? *

What is the website that features your products?

Please write in link to your company logo:

Is your business a?

MWBE

Small-business (under 20 employees)

n/a

Clear selection

What do you consider yourself? *

Manufacturer

Wholesale/Supplier

Both

Please confirm you have a business EIN *

Yes

What are you selling (or renting)? *

Face masks and coverings (e.g. cloth face masks/coverings, surgical masks, N95 respirators)

Face Shields

Gloves

Cleaning and disinfectant products (e.g. sanitizer)

Physical enhancements and portable furniture (e.g. plastic shield walls, sneeze guards, physical barriers/partitions)

Other (e.g. goggles, gowns, aprons/smocks, air filters/ventilation systems, thermometers)

I'm selling more than one product

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms