Kairos Health Services Mask Order Form

Kairos Health Services is an official FDA Registered Medical Device Establishment.
Thank you for your interest in ordering Personal Protective Equipment from Kairos Health Services.

We are honored to help supply a variety of approved masks to our medical and community workers and others during this time.

Please click the link below to view our products and order from our new website.

www.kairoshealthservices.org
Name

First NameLast Name
Email
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState

Zip Code
What occupational field(s) best describe where the masks will be used?
select all that apply
If you are affiliated with a clinic or health care facility please list the name of the facility and your role
Products

N95 GarryGalaxy SINGLE USE MASKS

$4.79 each + tax

In Stock

PPMA KN95 SINGLE USE MASKS

$44.30 for a package of 10 masks + tax

**Currently Unavailable**

SINGLE USE SURGICAL MASKS WITH ELASTIC

$65/box of 50 masks + tax

please contact us at info@kairoshealthservices.org if you need to order a smaller amount

**Currently Unavailable**

SINGLE USE SURGICAL MASKS WITH ELASTIC

$75/box of 50 masks + tax

please contact us at info@kairoshealthservices.org if you need to order a smaller amount

**Expected arrival date 4/29/20**
Purchase Order
GarryGalaxy single use N95 masks
Quantity of individual masks
GarryGalaxy Total:
Currently Unavailable** PMMA single use KN95 masks:
Quantity of packages (10 masks/pkg)
PMMA Total:
Currently Unavailable** Single use surgical masks with ties
Quantity of boxes (50 masks per box)
Surgical Ties Total:
Single use surgical masks with elastic:
Quantity of boxes (50 masks per box)
Surgical Elastic Total:
Sub Total:
Tax:
TOTAL
(You will pay this below)
Please contact us at info@kairoshealthservices.org if you need to use a different form of payment other than debit or credit card.
Sales Tax
Quantity Ordered:
Preferred pick-up location
Shipping Name and Address
We will contact you concerning shipping cost and payment
Quantity of GarryGalaxy single use masks you are ordering
Payment Options:
What type of order is this?
TOTAL - Due Via Venmo or Check:
(Checks should be made payable to Kairos Health Services)
Should be Empty:

Kairos Health Services is an official FDA Registered Medical Device Establishment.