Face Mask Request Form - California Grocers Association

COVID-19 Facial Mask Request Form

Please complete the form below to register your interest in receiving complimentary employee face masks. You will receive an e-mail confirming receipt of your inquiry and a status on your request in the coming days. If you have any questions, please email Doug Scholz, CGA, at [email protected].

Name*
First Last
Company Name*
Email*
Mobile Phone*
Total number of stores in company*
Are your stores operating under an ordinance mandating employees wear face coverings?*
- Yes
- No
Who is your primary wholesaler?*
- C&S Wholesale Grocers
- UNFI
Mask quantities needed*
Emergency needs (Quantity needed immediately)
Secondary needs (Quantity needed within a few months)
Secondary needs (Quantity needed within a few months)
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Email
This field is for validation purposes and should be left unchanged.