Colorado Mask Project Mask Request Form

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Welcome to the Colorado Mask Project!

IMPORTANT: AS OF 6 NOVEMBER 2020, COLORADO MASK PROJECT IS NOT ABLE TO TAKE ON NEW MASK REQUESTS. IF YOU STILL CHOOSE TO FILL OUT THE FORM, WE WILL CONTACT YOU IF WE ARE ABLE TO FILL YOUR REQUEST IN THE FUTURE. WE STRONGLY RECOMMEND PURCHASING MASKS. THERE ARE MANY VENDORS AVAILABLE FOR ANY NUMBER OF PPE NEEDS, LISTED HERE:

1-25 Masks: https://airtable.com/shrLYc7PGvGvs3lNB
25-100 Masks: https://airtable.com/shrfH5bYUEvh1UOQ6
100-1000 Masks: https://airtable.com/shry5n5jMbQg6kl7I
1000+ Masks: https://airtable.com/shrJd7IyF8TWHj9cc
Children’s Masks: https://airtable.com/shrhVEeQomnhLds2A
Face Shields: https://airtable.com/shrS6g6lnYCtnXAVB
Gowns: https://airtable.com/shrrDx1pmV0gJO5GO
Caps: https://airtable.com/shrslTBwrPXwl6myI

PLEASE NOTE: This form is ONLY for facilities that are unable to purchase cloth masks as a cost of doing business. If you are able in full or in part to purchase cloth face coverings, please visit the Resources and Partners section of the Colorado Mask Project website (https://www.coloradomaskproject.com/resources-partners#partners).

If you are a healthcare facility, NGO, non-profit, or other organization that needs a DONATION of 10 or more masks, please list your cloth face mask needs here.

Email *

Organization Name *

City *

Cloth face coverings are considered a cost of doing business. Is your facility able to purchase cloth masks? *

Yes

Partial purchase

Needs donations ONLY

How many masks do you need? *

How urgent is your need for these masks? *

Emergent (completely out of stock)

Urgent (running out of stock)

Not Urgent (anticipatory measures)

Contact Name *

Department Name

Phone Number *

Delivery Address *

Zip Code *

Please provide a short description of your business *

Who will be using the masks? *

Do you need your masks to have a pocket for a filter to be added? *

WITH a filter pocket

WITHOUT a filter pocket

Don't care

Do you need your masks to have wire over the nose-bridge? *

WITH a wire nose-bridge

WITHOUT a wire nose-bridge

Don't care

Do you need masks that fit over an N95 respirator? *

DOES need to fit over an N95 respirator

DOES NOT need to fit over an N95 respirator

Don't care

Do you have a specific pattern of mask that you would prefer?

Questions or additional comments:

How did you hear about Colorado Mask Project? *

Send me a copy of my responses.

Submit

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