State of Texas COVID-19 PPE Supplier Survey

Please fill out the form below and submit.

Question Title

* 1. Contact Information

Name *

Company *

City/Town

State/Province *

ZIP/Postal Code *

Country *

Email Address *

Phone Number *

Question Title

* 2. My company has the ability to provide the following:

N95 Masks

Face Shields

Procedural Masks

Surgical Gowns

Hand Sanitizer

Disinfectant Wipes

Ventilators

Heaters