Face Masks Order Form - Team Corona Busters

How can I order face masks for our hospital?

Use the order form below. Face masks are only being distributed to doctors and nurses working at hospitals. You are required to upload a copy of your valid healthcare credentials.

Name *

First

Last

Company Name *

The primary focus has always been to provide masks for doctors and nurses in hospital ICU’s and emergency departments, however Team Corona Busters will consider caregivers and individual healthcare workers. Please provide more information in the comments field.

Email *

Telephone *

Use this style xxx-xxx-xxxx if in the US.

Street Address 1 *

Street Address 2

City *

State or Province *

ZIP Code *

Country *

Use the comments section if not in the US or Canada.

How many face masks do you need? *

Use comment section to explain if needing more than 20 face masks

Pickup or Delivery *

Comment or Message

File Upload (max 4MB) *

Click or drag a file to this area to upload.

In an effort to ensure our face masks are provided to front line defenders only, you are required to upload a copy of your valid credentials. If the file will not upload, be sure to decrease the size below 4MB. Available file formats to upload include jpg, jpeg, png, pdf.

Agreement *

Check YES to indicate that you have read and agree to the Terms of Use and that you will never sell our face masks, fabric or anything else acquired from Team Corona Busters that are expressly meant to be given, at no charge, to front line defenders in response to the COVID-19 coronovirus pandemic.

Name