PPE Request Form for St. Lawrence County Producers
Cornell Cooperative Extension of St. Lawrence County is the distribution point for free hand sanitizers and face masks for St. Lawrence County agricultural businesses. If your business is located outside St. Lawrence County, contact your local Cooperative Extension for distribution information. Priority will be given to farms who were not served in May during the first round of distribution, but all eligible producers are encouraged to sign-up if additional product is needed.

How to secure the materials:
1. Complete this form with contact information and quantities requested.
2. CCE will confirm your request by email or phone and let you know supplies are packed for pick up.
3. Pick up materials at 2043 State Highway 68 Canton, NY.

If demand is high the amount distributed to your farm will be proportionally reduced. If pickup at Learning Farm is not possible, complete form and request delivery.
Thank you,
The Ag & Food Systems Department
Questions:
315-379-9192, ext. 229, mpf65@cornell.edu
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Email *
Producer Name(s) *
Business Name *
Full Mailing Address (Street, Town, Zip) *
Phone Number 1 *
Does this number accept texts? *
Phone Number 2
Does this number accept texts?
Clear selection
Did this business already receive PPE in the first round of this distribution (May 2020)? *
Including owners, how many people does this operation employ? *
Mark one selection that best describes where these supplies will be used.
Clear selection
How many face coverings do you request? *
How many 2 ounce containers of hand sanitizer do you request? These containers are refillable. *
How many 1 gallon containers of hand sanitizer (includes hand pump) do you request? *
Confirm method to receive supplies. *
Additional Comments
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