Face Shield Request Form
IMPORTANT NOTE: These are not medically-certified face shields and are provided with no warranty of any kind (details on the source of the design etc at the bottom of this form). Registering in this form does not guarantee receipt of items - we will produce what we are able but if we are overwhelmed with demand we may not be able to meet all requests.
Name
*
First Name
Last Name
Department/Organization
*
What agency or entity is making the request
Email
*
example@example.com
Address to ship the face shields (at this point only U.S. addresses eligible)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Number requested
*
1
2
3
4
5
6
7
8
9
10
Initially we are limiting requests to 10 pieces while we get a sense of demand and to ensure more small agencies can have access to at least some equipment. Please note in the comments below if your needs exceed this and we will see what we can do, if anything
Comments
*
Signature - By typing my name here, I certify that this request is for a first-responder agency, not for personal use or re-sale. I also acknowledge that these items, if available, are provided as-is and with no stated or implied warranty for medical effectiveness. I also understand that Bounce will ship these on an as-available basis, with no guarantees that supplies will not be exceeded by demand from departments
*
Please verify that you are human
*
More information on the Prusa Face Shield open source project
HERE
Submit
Should be Empty: