PPE Supplier Form

What types of PPE is your business manufacturing/producing/distributing? (Select all that apply):

If donating, do you have any guidelines as to who you want to donate to (i.e. hospitals, first responders, food pantries, etc.):

If selling, are there minimum quantities required:

Is there any bulk discount:

Have you registered with Pure Michigan Business Connect (PMBC):

Are you willing to have us share your contact information with those organizations in need of supplies:

Are you willing to have your organization and applicable contact information listed in the public West Michigan Personal Protective Equipment Manufacturers List: