PPE Request Form

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Personal Protection Equipment Request Form

The Wyoming County Office of Emergency Management has a provided a limited amount of free KN95 masks, COVID test kits, and hand sanitizer available on a first-come, first-serve basis as supplies last.

Please fill out the form below and click the submit button. You may also call (585) 786-0307. You will be notified by email when and where the supplies will be available for pick-up.

Firstname *

Lastname *

Business Name *

Address *

City *

State *

Zipcode *

Phone *

Email *

Please indicate items needed and desired quantities below.

KN95 Masks

Quantity requested

COVID Test Kit (2 test/pack)

Hand Sanitizer - 1 Gallon bottle

Enter Quantity Requested

Additional Comments or Questions

Security Check *