Application for Donated Masks

Organization Name

Type of Organization

School, non-profit, etc.

How did you hear about us?

Organization Information

Organization Website

http://

Facebook

Please enter full URL for your organization's Facebook page.

http://

Twitter

Please enter full URL for your organization's Twitter page.

http://

Please enter full URL for your organization's LinkedIn page.

http://

Instagram

Please enter full URL for your organization's Instagram page.

http://

Tell us about your organization.

Size of organization

How many individuals does your organization serve?

Contact Information

Point of Contact Name

First Name

Last Name

Point of Contact Position

Point of Contact E-mail

Does your organization have a dedicated point of contact for social media and/or communications?

Yes

Social media/communications Contact Name

First Name

Last Name

Social media/communications Contact E-mail

Questions

How would ClearMask™ help make an impact?

Describe how your organization would benefit from the ClearMask™ transparent masks. If applicable, please explain your financial need.

Have you ordered or used ClearMask™ before?

Number of ClearMask™ transparent masks requested

Please also specify which product line you are requesting (visit www.buy.theclearmask.com to see available options).

How can you help raise awareness about ClearMask?

Anything else we should know?