Black Hammer Wisconsin COVID-19 Supplies Request Form
Black Hammer Wisconsin Disaster Relief -- Protecting the People. If you are a Colonized Person living in the Milwaukee or Madison areas we will be delivering N-95 masks, gloves, hand sanitizer and natural cold fighting herbs. Please fill out this request forum and we will provide an update to you for the estimated date for your no-contact delivery within 48-72 hours. BHMIDWEST@PROTONMAIL.COM
Sign in to Google to save your progress. Learn more
Name + Pronouns *
Email *
Address + Delivery Instructions *
Phone number *
How many people are the supplies for? *
Check the items you need * *
Required
If you have information on unstably housed individuals who are in need of supplies, please share their information here or refer them to us.
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