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I Need Supplies
Organization and Contact
Organization Name
Organization Address
City
State
Postal Code
Contact Name
Contact Title
Contact Email
Contact Phone
Nature of Organization
Type of Equipment Needed
Isolation Gowns
Latex Gloves
Masks / Face Shields
N95 Masks
IV Drip Apparatus
Ventilators
Request Resources
Resource
Quantity
N95 Masks
N95 Masks Quantity
Surgical Masks
Surgical Masks Quantity
Isolation Gowns / Suits
Isolation Gowns / Suits Quantity
Nitrile Exam Gloves
Nitrile Exam Gloves Quantity
Facial Shields
Facial Shields Quantity
Sanitary Wipes
Sanitary Wipes Quantity
Infrared Thermometers
Infrared Thermometers Quantity
Other Personal Protective Equipment
Quantity of Supplies Needed
Math question
1 + 17 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.