SC COVID-19 Manufacturers/Distributors Survey

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* 1. Point of Contact

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* 3. I/we are capable of doing the following: [Select all that apply]

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* 4. [CRITICAL NEED ITEMS]  I/We are capable of providing and/or producing the following critical need supplies and/or equipment. [Select all that apply]

Note: Any additional detail related to items may be noted in the Comments/Notes field below.

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* 5. [GENERAL NEEDS] I/We are capable of providing and/or producing  the following supplies and/or equipment.  [Select all that apply]

Note: Any additional detail related to items may be noted in the Comments/Notes field below.

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* 6. What quantity of the identified supplies, materials, and/or equipment can you provide?

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* 7. If producing these supplies, materials, and/or equipment how many can you produce in one week?

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* 9. What is the earliest date these supplies, materials, and/or equipment will be available?

Date

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* 10. Comments/Notes: (please consider using this space to provide any specific information that would help us better understand your capabilities or the items you have available, include quantities, sizes, specifications)

T