Mask Request Form

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Mask Request Form

Complete this form to requests masks to be made by one of our volunteers. One per person please. If you own a mask and are requesting another, please donate the one you no longer need to help save lives.

If purchasing a mask is a financial hardship, please continue and complete the request form below. If you are able to contribute for your mask, it is greatly appreciated. Donations can be sent to lexislarue@gmail.com via PayPal.

Email *

Phone number *

First and Last Name *

Organization - if no organization, please enter SELF *

Do you currently own any masks? If so, how many and what kind? *

Mask Sizes

Enter quantity of each size you are requesting in the following sections.

XL Adult

Typically for men with beards

M/L Adult

Standard Size

Small Adult

Teen/XS Adult

Good for teens as well as smaller adults

Child Size Large

7-10 yrs old.

Child Size Small

3-7 yrs old. Children 2 and under should not wear masks.

Additional item requests

Ear savers

Specify Qty in Comments

Please rate your urgency level (1-5) and give us a brief explanation: *

Notes

Please provide any additional information you feel is important. We will try to meet your needs as quickly as we can.

Thank you for your support. We will contact you when your masks are ready.

Send me a copy of my responses.

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