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Floris UMC Homemade PPE Request Form
We will do our best to fill your needs. If you are also interested in volunteering to sew or donate to the cause, please fill out the volunteer form:
https://forms.gle/VDtPiUXt25taHp1H6
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* Indicates required question
Email
*
Your email
Name of Facility
*
Your answer
Facility City
*
Your answer
Facility State
*
Your answer
Please share your name and title
*
Your answer
How do you know the facility needs masks?
*
Your answer
Will the facility accept home made masks?
*
Yes
No
I'm not sure
Phone Number
*
Your answer
Can we text you?
*
Yes
No
Other:
Best Method to Deliver
*
Masks should be shipped
Masks should be dropped off
Either
Address (please include any specific drop off instructions)
*
Your answer
Quantity and sizes (child or adult) Requested
*
Your answer
If you need surgical caps, please share the quantity needed below
Your answer
If you need gowns, please know we ask for additional support in donations due to increased material cost of the item ($3.50 a gown). Please share the quantity of gowns needed below.
Your answer
How many nurses/staff does your organization support
*
Option 1
When should masks be sent/dropped off?
*
As the come in - as soon as possible
When you have 100 or more collected
Please make the masks but hold on shipping/dropping right now
Other:
Any additional information or comments?
Your answer
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