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Oxford County Hand Sanitizer Request Form
UMO/MEMA Hand Sanitizer Request form
PLEASE EXHAUST ALL LOCAL OPTIONS PRIOR TO PLACING A REQUEST
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* Indicates required question
Email
*
Your email
Hand Sanitizer Number of Gallons Requested
*
Please enter in 1 or 5 gallon increments
Your answer
Organization Name
*
Your answer
Point of Contact Name
*
Your answer
Point of Contact Phone
*
Your answer
Organization Delivery Address
*
Your answer
Organization Daily Consumption Rate of Hand Sanitizer
*
Please tell us the amount of hand sanitizer used daily at your facility (in ounces, gallons or some other unit of measurement), otherwise, your order will be held up.
Your answer
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