Kittitas County Chamber of Commerce Small Business PPE Request Form
RequiredRequired Question(s)
PPE distribution is coordinated by the Kittitas County Chamber of Commerce located at 609 North Main Street in Ellensburg, WA. Small business PPE is only open to those with 20 or less full time employees. If you need assistance filling out this form call (509) 925-2002 or email our CEO Amy McGuffin at amy@kittitascountychamber.com. PPE will be distributed on TBD (date depending on responses). 
 
Required 1.

Business Name:

 

350 characters left.
Required 2.

Business Owner/Representative Name:

 

50 characters left.
Required 3.

Email: 

 

50 characters left.
Required 4.

Phone:

 

50 characters left.
Required 5.

Name of person picking up PPE:

 

50 characters left.
Required 6.

Number of Employees:

 

50 characters left.
Required 7.
PPE Request: N95 Masks
Yes
No
Required 8.
PPE Request: Cloth Masks (limit 2 packs of 50 per business)
Yes
No
Required 9.
PPE Request: Gloves (limit 2 boxes per business)
Yes
No
Required 10.
PPE Request: Thermometers (limit one per business)
Yes
No
Required 11.
PPE Request: Hand sanitizer (limit 2 one gallons jugs per business) 
Yes
No
Required 12.
PPE Request: Lysol whips (limit 2 canisters per business)
Yes
No
Required 13.
PPE Request: Disinfectant concentrate (limit 2 one gallon jugs)
Yes
No
14.
Please leave any comments or additional information below if needed: 
 

50 characters left.