Hospital & Essential Workplace Request Form

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Please provide us information about yourself, and the hospital/essential workplace you are associated with.

These face masks are made with cotton or cotton blend material by our Creators.

Masks will be shipped or dropped off directly to the address you provide.

All masks are washable, please wash them prior to use, and after each wear.

Please provide any required mask specifications for your workplace, if applicable.

Hospital or Company Name *

Hospital / Company Location (City, State) *

Full Legal Name *

Email *

Shipping Address For Masks: *

Phone number *

How many masks do you need? *

On a scale of 1-10, how bad do you need face masks?

Row 1

Clear selection

Please list if your hospital/essential workplace has any specific mask requirements.

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