PPE Distribution Through the Simi Valley Chamber of Commerce

PPE Request Form
We stil have a limited supply of KN-95 masks available for our business community.

We are out of hand sanitizer and surgical masks.

If you are interested in the KN-95 masks, please fill out the form below. We are asking to limit your request to 10 masks per employee.
Name*

First NameLast Name
Company*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail*
Phone Number*

Area CodePhone Number
# of Employees
# of Unvaccinated Employees *
KN-95 Masks - Number of Masks Requested (We are currently able to offer a maximum of 10 masks per employee).
3-Ply Non Surgical Masks Requested
Is your business a member of the Simi Valley Chamber of Commerce*

YesNoI Don't KnowOther
Comments
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PPE Request Form