ORDER FORM

The Free Small Business Rapid Antigen Program is here to help you and your employees.  
Please feel free to place your order below!


DISCLAIMER:  Screening kits are an added measure but all other PPE and distancing protocols must continue to be followed regardless of screening.

The Chamber will notify you via email when your kits are ready for pick-up.

Your Screening Supervisor Designate MUST be the person collecting the screening kits and will be required to watch a 5-minute instructional video upon arrival. Kit collection will take place inside the Chamber building.

Please DO NOT visit the pick-up locations until you have heard from us. You will receive a confirmation email with all pertinent information along with your pick-up date and time.
Sign in to Google to save your progress. Learn more
Your Business Name *
City (Business Location)* *
Business Telephone Number *
Contact Name (Screening Supervisor Designate) *
Screening Supervisor Designate Mobile Number *
Screening Supervisor Designate Email Address (confirmation will be sent to this address) *
Number of Employees you will be Testing (you will receive enough kits to test each employee twice per week for a two-week period) *
Picking up your order *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy