Exit this survey Three-Ply Face Mask Order Question Title * 1. How many surgical masks are you ordering? Question Title * 2. Name of the person picking up and paying for the order at the KHCA/KCAL office on Wednesday, July 22. Question Title * 3. Nursing facility/ Assissted Living/ Home Plus/ Residential Health Care Facility/ organization name Administrator/ director name Address Address 2 City State ZIP Email Phone Question Title * 4. I understand that I need to bring payment of credit card or check (payable to Steve Rust) when I pick up my mask order at KHCA/KCAL 's rear door on Wednesday, July 22, between 9am and 3pm. I also understand that I need to calculate payment using . $ 0.65 cents per mask plus 9.15% for sales tax. Yes No Done
