Hospitals RFQ - Request a Quote for Safety Supplies

For Hospital Inquiries - Emergency RFQ

Tell Us Who You Are and What You Need.

In these times of uncertainty, when products are more difficult to source due to demand, we set up this online form to expedite access to medical supplies. We do not have everything, but we are able to source some key products like Covid19 test kits, N95, and other masks.

If you were sent this form, it means that you've spoken to one of our associates and they feel we may be able to help you in these difficult times. Please fill in the form and click the submit button. Our team will be in touch within 24 hours. Thank you for serving our communities. This information is required to calculate price, source and lead time.

Name *

First

Last

Hospital Name/ Company *

Email *

Phone *

Do you prefer to be contacted by phone or email? *

Preferred Delivery Date

Shipping Address *

Address Line 1

Address Line 2

City

State

Zip Code

Billing Address if different than shipping address

Address Line 1

Address Line 2

City

State

Zip Code

N95 masks

(enter total units)

3 Ply Level 3 Masks

(enter total units)

Sanitizers

(enter size and total units)

COVID-19 Test Kits

(enter total units)

Other

(enter item and total units)

Any Special Instructions/ Comments/ or Larger Quantities

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