PPE Supplier Form




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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: