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DMV Fighting COVID - 3D Printed Personal Protective Equipment (PPE) Request Form
Please fill out the form below to inform us of your PPE needs for your organization.
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* Indicates required question
Name of organization:
*
Your answer
Location of organization:
*
Your answer
Point of contact:
*
Your answer
Email address:
*
Your answer
Confirm email address:
*
Your answer
Phone number:
*
Your answer
What type of 3D printed PPE do you need? How many units of each type of PPE do you need?
*
Your answer
Do you require any particular specifications for 3D printed PPE? Are there any special procedures to be followed?
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Your answer
We are currently counting on organizations to sanitize the face shields and door openers after final delivery. Is this acceptable for your organization?
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Yes
No
Other:
Are you in need of other PPE? If so, what are your other needs?
*
Your answer
Additional questions, comments, and/or requests:
Your answer
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