Orange County Small Business Coronavirus Response Form
We have a looming shortage of personal protective equipment for our Orange County health care workers and law enforcement officers. That's why I'm personally requesting that any private businesses or individuals with manufacturing capacity manufacture or donate gowns, face shields, masks (especially N95 or P100 masks), gloves, swabs, or other resources that could help hospitals.


Please fill out this form if you can donate any unused, professional-grade N95/P100 masks, gloves, gowns, face shields, swabs, goggles, or other resources. Every piece of protective equipment helps.


Thank you for supporting health workers in Orange County on the front lines in the fight against COVID-19!
Sign in to Google to save your progress. Learn more
Email *
Please fill out this form if you are an individual or are representing a business that is able to provide protective health care equipment
What is your name? *
What is your companies name? (Legal and DBA name)
What supplies can you provide? *
Required
If you are representing a business, what is your company type? *
If you are representing a business, does your manufacturing facility have an export license?
Clear selection
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