Rapid Antigen Test Kit Order Form

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The form below can be used for both your first order and refill orders of rapid antigen test kits.

Upon completing the form form your test kits will be ready for pickup. We kindly ask you call or email the chamber before picking up to ensure we are available.

Business Name *

Contact Name *

Email Address *

Telephone Number *

Number of Kits required (1 week supply based on 5 tests/kit per employee) *

Rapid Antigen Test Kit Order Form *

First Pick Up

Refills

Attestation

Your Screening Supervisor Designate is required to watch instructional video below before your first pickup. This video demonstrates how to properly conducting the self screening, and can be shared with all your employees. You will be required to make an attestation below that your Designate has watched the video.

https://www.youtube.com/watch?v=ikEK2EC_okc

I hereby attest that the Screening Supervisor Designate has watched the above training video. *

Required

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