Vendor Form

The Delaware Valley Industrial Resource Center (DVIRC) has created a cloud-based platform to address the growing number of supply chain inquires related to the urgent needs of medical professionals as they fight the coronavirus disease (COVID-19).

If you are a business in the region who can provide critical personal protective equipment (PPE) and /or COVID-19  related medical supplies, please complete this form

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* 1. Company Name

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* 2. Contact Name

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* 3. Contact Email

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* 4. Product Description - Please use this space to describe what it is that you can provide.

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* 5. Product Volume - Please use this space to describe the potential volume of product that you provide.

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* 6. Current Certifications - Please list any current certifications that you hold. 

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* 7. Estimated Availability - If presented with a purchase order what is your estimated turn time? 

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* 8. Personal Protection Equipment (PPE)  (Select all that apply)

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* 9. Hospital Supplies (Select all that apply)

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* 10. Lab Supplies  (Select all that apply)

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* 11. Diagnostics Supplies and Instruments (Select all that apply)

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* 12. Other products (Please specify)

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* 13. Do you have product specifications or product images? (if yes, please send it to kenright@dvirc.org.)

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