SurveyMonkey Powered Online Survey

By filling out this form you are requesting a shipment of KN95 masks for your library. Please enter your name and library in the brief form below. Mask information:
BYD KN95 mask - Specifications (JPEG)
NPPTL Assessment-BYD Model DG3101

Thanks.

Question Title

* 1. Your name

Question Title

* 2. Your library

Question Title

* 3. Are you on Van Delivery?

Yes

No

Question Title

* 4. Please supply your mailing address if you are not on the van delivery service and we will mail masks to you via USPS.

Street Address

City or Town

Zip Code

Question Title

* 5. How many masks would you like?

20 (10 packages, 2 in each package)

50 ( 1 box, 25 packages, 2 in each package)

100 (2 boxes, 50 packages, 2 in each package)

Question Title

* 6. Comments