PPE Request Form

County
Name
First Last
Email
Date you would like to pick up (if available):
MM slash DD slash YYYY
Hand Sanitizer - 6pk bottles with pump dispenser (1 pack per county)
Please enter a number from 0 to 1.
N-95 Particulate Filter Resperator and Surgical Mask - 50 Count box
Please enter a number less than or equal to 1.
Disposible non-medical face masks (ear hooks - non tie) 50 count box
Please enter a number less than or equal to 3.
N95 Respirator Masks - Non Medical - Individually packaged
Please enter a number less than or equal to 85.
KN95 Protective Masks - Non Medical - 20 count box
Please enter a number less than or equal to 2.
Direct Splash Protection Face Shield - 10 pack
Please enter a number less than or equal to 3.

District 6 Administrative Services