MY Project USA - PPE Request Form For A Family

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THIS FORM IS FOR A FAMILY OR INDIVIDUAL REQUEST ONLY.
Please fill up this form to request a donation of Hand Sanitizers, Face Masks, Face Shield and Trash Bags from MY Project USA. We will scan your request and will do our very best to provide you with these items as they are available. The distribution will be based on supply and demand basis with focus on serving the most vulnerable and needy families within our communities.

Email *

Client's Full Name *

Client's Cell Phone *

Client's Email *

Number of Adults in Household *

Number of children in the household *

Items Requested *

Hand Sanitizers

Cloth Face Masks

FDA Approved Disposable Face Masks

Antibacterial Soap

Sanitizing Wipes

Sanitizing Spray

Option 7

Other:

Required

Can you pick them up from our warehouse off of Fisher Rd. 43228? *

Yes

Any additional comment/suggestion

Send me a copy of my responses.

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