Mask Request
South Bend Seamstress is trying to do our part to help fill the mask needs of the essential work force during this time. If you are considered an essential worker and need a mask, please enter your information below. We will fill these requests on a first come, first served basis. Limit one per person.

Disclaimer: These masks are a 100% cotton fabric, double layered, pleated mask. They are not intended to be substituted for N95 masks or similar. South Bend Seamstress does not guarantee any type of protection by using this mask. Your information will not be used or sold for any mailing lists.

If you have any questions, please email us at info@southbendseamstress.com.
Sign in to Google to save your progress. Learn more
First and Last Name *
Email Address *
Phone Number *
Place of employment / Industry *
Do you prefer elastic or fabric ties? *
Would you prefer to pick up your mask or have it mailed to you? *
If you want your mask mailed, please provide your mailing address. (Will be mailed via USPS First Class Mail.)
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms