Mask Bloc 301 - Mask Request Form

Mask Bloc 301 - Mask Request Form
Fill out this form to receive FREE masks from Mask Bloc 301. We provide contactless delivery and pickup throughout so-called "Maryland".

Si necesita este formulario en español: presione el botón que dice "🇺🇸 English (US)" en la esquina superior derecha de este formulario y elija "🇪🇸 Spanish (Latin America)."

This form is for individuals and households. If you are organizing an event or are interested in handing out a larger amount of masks, please email us at MaskBloc301@proton.me.

If you have the means to purchase masks on your own, links to several lower-cost mask options can be found at our🔗Linktree. You can email us at MaskBloc301@proton.me or DM us on Instagram @MaskBloc301 if you'd like additional options!

Disclaimer: We try our best to meet urgent requests, but deliveries can take up to 4 weeks to fulfill depending on our availability.

Please see our service area map below to see if we take requests in your area - blue/square pins mark delivery areas, and red/circular pins mark pick-up locations. If you live outside of our mapped areas, we are still able to schedule a pickup if you are able to meet us within our service area. Please note that this map may change.
First Name*
Please enter your first name, nickname, or alias ONLY
Email*
example@example.com
EnglishSpanish
Pick up in California, MDPick up in Ellicott City, MDNo, I can’t pick up at this locations. Please deliver to me instead.
Zone 1: Prince George’s CountyZone 2: Gaithersburg, Montgomery Village, Germantown, ClarksburgZone 3: Rockville, Silver Spring, BethesdaZone 4: Southern Maryland (Charles, Calvert, & St. Mary's Counties)Zone 5: Columbia, Laurel
IF YOU ARE NOT IN ONE OF THESE DELIVERY AREAS AND CAN'T PICK UP: Email MaskBloc301@proton.me and we will do our best to help find a solution for you!
Where will we be delivering the masks?*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What is required to access this location (key pad code, call-in)? If none, write N/A. *
Do you need your masks by a certain date?

MonthDayYear
How many total people are you requesting masks for?*
How many adults with large faces?*
How many adults with small faces?*
How many children?*
What are the ages of the children?
This will help us pick the best sized masks for everyone.
How many masks do you need?*
We are able to provide up to 20 masks per person in your request. If you would like that amount, please type "MAX". Otherwise, please let us know how many masks you need.
Do you need masks that can be used for an MRI test? (A special medical test)*
These adhesive N95 masks are metal-free and not intended for daily use. We offer ReadiMasks in size Large.
If yes, how many MRI masks do you need?
We generally recommend one mask for each upcoming MRI you have.
Mask Key

This is what each mask type generally looks like.
- Our stock currently includes (Exact stock varies by location):
  
  Trifold N95: 3M Aura 9205+, 3M Aura 1870+
  
  Bifold N95: BYD Care N95
  
  Bifold KN95: 3M 9501+
  
  Duckbill: Kleenguard N95, Gerson N95 (duckbills tend to be most breathable)
  
  All of our children's masks are Trifold KN95 with ear loops.
- Trifold N95Bifold N95 (head straps)Bifold KN95 (ear loops)Duckbill N95No preference
- Trifold N95Bifold N95 (head straps)Bifold KN95 (ear loops)Duckbill N95No preference
- Please leave any additional mask preferences or needs.
  Example: I prefer trifolds, but my family member prefers duckbills, so please provide a mix of both.
- Mask availability is subject to change. If we do not have a mask you select, we will do our best to provide a similar alternative.
  
  For deliveries: We will try to meet special communication and/or scheduling requests, but can not make any guarantees. If we do not hear back 48 hours after emailing you about a special request, we will move forward with fulfilling your request. If you would like to cancel, email us any time at MaskBloc301@proton.me.
- Please list any additional questions, comments, potential urgency needs, or privacy/security needs.
- IMPORTANT NOTE: Our emails are sometimes automatically sent to spam. Please check your spam folder regularly while waiting to hear back from us.
- My email and delivery address are spelled correctly
- Should be Empty:

Mask Bloc 301 - Mask Request Form

Mask Key