Coronavirus – Disposable Surgical Mask Order Form COVID-19 PPE Supply Order - Disposable Surgical Masks Company Name*Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Contact Name*Contact Email* Contact Phone*CAUTIONThese masks will cost you $0.56 each, plus tax. We will invoice you for the cost of the masks and shipping, if applicable. If you are looking for the FREE cloth face coverings, please go to our PPE page and select the FREE cloth face covering order form.# Disposable Surgical Masks*Boxes come in quantities of 50 - please indicate the total number of masks you would like to order in segments of 50.How would you like to get your mask order?*You will make arrangements to pick them up at our office located at 142 Whitten Road. We are open 8am-5pm Monday through Friday, however, we are not accepting outside visitors. The way we will work this is we will leave your boxed order in the front entrance vestibule on the day you tell us you will pick them up. Please let Makala (email@example.com) know the day you will arrive so we can have it ready.You would like us to ship the order to you via FedEx or UPS using your company’s shipping account.You would like us to ship the order to you via FedEx or UPS using MMTA’s shipping account and we will add that charge to your invoice for the masks.Comments:PLEASE NOTE:The original request to the State was for N95 masks and the ones we have ordered are disposable surgical masks that do not offer the same protection as N95 certified masks. Orders will be considered on a first come, first served basis and will depend upon availability.