Request for Face Mask - St. Landry Chamber of Commerce, LA

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Request for Face Mask

In order to stay in compliance with CDC safety guidelines, fill out this survey to receive facemasks for your employees. Supplies are limited, any donations will be distributed accordingly. Businesses do not need to be a member of the Chamber. Businesses must be located in St. Landry Parish. If we are able to fulfill your request you will be contacted by the Chamber for pick-up times.
Name

Title

First Name *

Last Name *

Suffix

Email Address *

Name of Business *

Phone Number *

Business Address

Address Line 1 *

Address Line 2

City *

State *

Zip/Postal Code *

Does your business need Facemasks for Employees? *

How Many of your Employees Need Facemasks? *
There is a limit of 5 Facemasks per business as supplies are limited.

Do you or your business want to donate masks to the Chamber for distribution *
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