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I NEED SUPPLIES
Supply Request
Organization and Contact
If your organization, hospital or business needs medical supplies, please fill out the form below.
Organization Name
Organization Address
Contact Name
Contact Title
Contact Email
Contact Phone Number
Nature of Organization
Non-profit?
Yes
No
Organization Tax ID
Type of Equipment Needed
Type of Equipment Needed
SUBMIT
Organization Name
Organization Address
Contact Name
Contact Title
Contact Email
Contact Phone Number
Nature of Organization
Non-profit?
Yes
No
Organization Tax ID
Type of Equipment Needed
Resource
Quantity
N95 Masks
N95 Masks
- None -
0-1K
1K-10K
10K-100K
100K-1M
1M-10M
10M-100M
100M+
KN95 Masks
KN95 Masks
- None -
0-1K
1K-10K
10K-100K
100K-1M
1M-10M
10M-100M
100M+
Surgical Masks
Surgical Masks
- None -
0-1K
1K-10K
10K-100K
100K-1M
1M-10M
10M-100M
100M+
Isolation Gowns / Suits
Isolation Gowns / Suits
- None -
0-1K
1K-10K
10K-100K
100K-1M
1M-10M
10M-100M
100M+
Nitrile Exam Gloves
Nitrile Exam Gloves
- None -
0-1K
1K-10K
10K-100K
100K-1M
1M-10M
10M-100M
100M+
Facial Shields
Facial Shields
- None -
0-1K
1K-10K
10K-100K
100K-1M
1M-10M
10M-100M
100M+
Ventilators - Invasive
Ventilators - Invasive
- None -
0-1K
1K-10K
10K-100K
100K-1M
1M-10M
10M-100M
100M+
Ventilators - Non Invasive
Ventilators - Non Invasive
- None -
0-1K
1K-10K
10K-100K
100K-1M
1M-10M
10M-100M
100M+
IV Drip Apparatus
IV Drip Apparatus
- None -
0-1K
1K-10K
10K-100K
100K-1M
1M-10M
10M-100M
100M+
Sanitary Wipes
Sanitary Wipes
- None -
0-1K
1K-10K
10K-100K
100K-1M
1M-10M
10M-100M
100M+
Infrared Thermometers
Infrared Thermometers
- None -
0-1K
1K-10K
10K-100K
100K-1M
1M-10M
10M-100M
100M+
COVID-19 Test Kits
COVID-19 Test Kits
- None -
0-1K
1K-10K
10K-100K
100K-1M
1M-10M
10M-100M
100M+
Other Personal Protective Equipment
Preference of Origin
If product is not immediately available from your preferred place of origin, do you still want to buy?
(
We will make every effort to source product from your preferred location of origin
)
Yes
No
Purchasing Budget
SUBMIT