MY Project USA - PPE Request Form For Small Organizations and under-served Community Groups
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.  
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Email *
Name of Agency/Group *
Contact's Name *
Contact's Cell Phone *
Contact's Email *
Number of cases of Hand Sanitizers Requested (A case of hand sanitizer has 6 bottles of 1.75L of Sazerac hand sanitizer). *
How often will you need this supply of hand sanitizers in the next 6 months. *
Number of cases of Liquid Soap Requested (A case of Soap has 28 bottles of 32oz of antibacterial soap). *
Number of cases of Trash Bags Requested (A case of trash bags has 4 boxes of 120 trash bags each). *
Number of Adult Cloth Face Masks Requested *
Number of Children Cloth Face Masks Requested *
Number of FDA Approved Paper Face Masks (disposable) Requested *
Number of Sanitizing Wipes Requested *
Describe the recipients. Their demographic. Why do you think you or your clients are the most eligible recipients? *
Can you pick them up from our warehouse off of Fisher Rd. 43228? *
Any additional comment/suggestion
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