PPE Donation Information Form
Tell us more about your donation
Main Contact Name:
Company name if it applies:
Street Address Line 2
State / Province
Postal / Zip Code
Please select all that you wish to donate:
Clorox bleach wipes (or equivalent)
Hand-sewn isolation gowns
New isolation gowns
Disposable coveralls/painter’s suits
Powered Air Purifying Respirators (PAPR)
Controlled Air Purifying Respirators (CAPR)
New N95 Masks
New Adult Masks
Hand-sewn Adult Masks
New Pediatric Masks
Hand-sewn Pediatric Masks
How many masks?
How many containers of Clorox Bleach Wipes?
How many bottles of Hand Sanitizer?
How many face shields?
How many goggles?
How many non-contact thermometers?
How many hand-sewn isolation gowns?
How many new isolation gowns?
How many disposable coveralls/ painter’s suits?
How many Powered Air Purifying Respirators (PAPR)?
How many Controlled Air Purifying Respirators (CAPR)?
When do you anticipate dropping off your donated item(s)?
Should be Empty: