What do you need?We’ll get in touch on availability and pricing. Organization Name * Organization Type * Government Health System Hospital Private Practice Private Individual Contact Name(s) * First Name Last Name Email * Please use your work/organization email address Phone Number * (###) ### #### 1) Filtering Facepiece Respirators (FFR) Colloquially, "N95 masks" Estimated Unmet Weekly Demand * None needed < 1,000 per week 1,000-10,000 per week >10,000 per week What certifications / marketing authorizations can you accept? NIOSH Europe EN 149-2001 (FFP2/FFP3) European CE Mark China GB2626-2006 (KN95) Japan JMHLW-2000 (DS/DL3; DS/DL2) Australia AS/NZA 1716:2012 (P3; P2) Brazil ABNT/NBR 13698:2011 (PFF3; PFF2) Korea KMOEL-2017-64) Mexico NOM-116-2009 Any required specifications? For example, a reference SKU from known US suppliers. 2) Isolation and Procedure Masks (with ear loops) Estimated Unmet Weekly Demand * None needed < 10,000 per week 10,000-100,000 per week >100,000 per week What ASTM Level is required? ASTM Level 1 ASTM Level 2 ASTM Level 3 Any required specifications? A reference SKU from known US suppliers would be helpful. 3) Surgical Masks Estimated Unmet Weekly Demand * None needed < 10,000 per week 10,000-100,000 per week >100,000 per week Any required specifications? For example - Type II vs. IIR; Differential pressure and liquid resistance requirement; strap type. A reference SKU from known US suppliers would also be helpful. 4) Isolation Gowns Estimated Unmet Weekly Demand * None needed < 1,000 per week 1,000-10,000 per week >10,000 per week Any required specifications? e.g. thumb hooks; ASTM level. A reference SKU from known US suppliers would also be helpful. 5) Coveralls Estimated Weekly Unmet Demand * None needed < 1,000 per week 1,000-10,000 per week >10,000 per week Any required specifications? A reference SKU from known US suppliers would be helpful. 6) Full Length Face Shields Estimated Weekly Unmet Demand * None needed < 1,000 per week 1,000-10,000 per week >10,000 per week Any required specifications? A reference SKU from known US suppliers would be helpful. 7) Fluid Protective Goggles Estimated Weekly Unmet Demand * None needed < 1,000 per week 1,000-10,000 per week >10,000 per week Any required specifications? A reference SKU from known US suppliers would be helpful. 8) Nitrile Gloves Estimated Weekly Unmet Demand * None needed < 50,000 per week 50,000-500,000 per week >500,000 per week Size Mix - what % are Medium, Large, vs X-Large? Any required specifications? For example, a reference SKU from known US suppliers. Please specify ideal size mix. What other products are you looking for? Please indicate your total desired quantity and if known, your daily & weekly demand. Please also indicate any necessary specifications, for example, a reference SKU from known US suppliers. Refundable 50% Deposit * In these unusual times, suppliers are asking for upfront payment. We are doing our best to negotiate payment terms within market conditions. Will your organization be able to wire a 50% refundable deposit to our 501c3 organization to secure an order? Yes No Shipping Shipping Address * Shipping City * Shipping State * Shipping Zip Code * Shipping Country * United States Afghanistan Algeria Argentina Bangladesh Brazil Burma Canada China Colombia Congo, Dem. Rep. Egypt Ethiopia France Germany India Indonesia Iran Iraq Italy Japan Kenya Korea, South Malaysia Mexico Morocco Nepal Nigeria Pakistan Peru Philippines Poland Russia South Africa Spain Sudan Tanzania Thailand Turkey Uganda Ukraine United Kingdom Uzbekistan Venezuela Vietnam Other Billing If different from shipping address Billing Address Billing City Billing State Billing Zip Code Billing Country United States Afghanistan Algeria Argentina Bangladesh Brazil Burma Canada China Colombia Congo, Dem. Rep. Egypt Ethiopia France Germany India Indonesia Iran Iraq Italy Japan Kenya Korea, South Malaysia Mexico Morocco Nepal Nigeria Pakistan Peru Philippines Poland Russia South Africa Spain Sudan Tanzania Thailand Turkey Uganda Ukraine United Kingdom Uzbekistan Venezuela Vietnam Other Are you currently treating COVID-19 patients? * Yes No Anything else we should know? Thank you! We will review your information and send you an email invitation to the flash sale once verified.
