Revised Order Request Form (Updated)

Marie Sources: PPE Purchase Order

Submit your desired products and quantities below.
Request Date

MonthDayYear
Date
E-mail
Full Name

First NameLast Name
Phone Number*

Country CodeArea CodePhone Number
Shipping Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Please note you must buy full boxes or packages. If you enter other quantities, I will contact you to adjust the quantity.

Minimum order quantities are 500 pcs for KN95s or Face Shields, and 1000 pcs for disposable masks.
1) Unit Price
1) KN95 Masks (60/box) - min. 540 pcs (9 boxes)
2) Unit Price
2) Disposable Masks (non-medical), 50/box, min. 1000 pcs
3) Unit Price
3) Surgical Masks (sterilized) 50/box, min. 1000 pcs
4) Unit Price
4) Face Shields, 5 pcs/package, min. 500 pcs
5) Unit Price
5) Loop Extenders (Multiples of 5)
Any additional order information:
Press Submit below so that I can review your request and obtain a shipping quote. No payment is required at this time.
Should be Empty:

Marie Sources: PPE Purchase Order