Business Supplies Form

Question Title

* 1. Are you are having trouble sourcing supplies, please indicate which ones (select all that apply)

No (end of survey)

Hand sanitizer stations/infrastructure

Hand sanitizer liquid

Physical barriers

Cleaning supplies

Other (please specify)

Question Title

* 2. Would you be interested in purchasing covid-19 related business supplies in bulk with other businesses?

Yes

No

Question Title

* 3. Please provide your email address;
*Someone will be in contact via this email address shortly after the form closes on June 15th, 2020.

Business Name

Email Address