Kittitas County Chamber of Commerce Restaurant 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. This PPE is open to restaurants. N95 Masks, cloth masks, gloves, thermometers, lysol wipes and disinfectant concentrate and propane heater refills will be permanently given to registered restaurants, while tents and/or tarps will be on a check-in/check-out basis with the Chamber. 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). We are hoping to order propane refills and tents/tarps starting Wednesday, December 23, so get your answers in now. 
 
Required 1.

Business Name:
 

350 characters left.
Required 2.

Business Owner/Representative Name:
 

50 characters left.
Required 3.

Business Address:
 

350 characters left.
Required 4.

Email: 
 

50 characters left.
Required 5.

Phone:
 

50 characters left.
Required 6.

Name of person picking up PPE:
 

50 characters left.
Required 7.

Number of Employees:
 

50 characters left.
Required 8.
PPE Request: N95 Masks (limit 2 packs of 50 per business)
Yes
No
Required 9.
PPE Request: Cloth Masks (limit 2 packs of 50 per business)
Yes
No
Required 10.
PPE Request: Gloves (limit 2 boxes per business)
Yes
No
Required 11.
PPE Request: Thermometers (limit one per business)
Yes
No
Required 12.
PPE Request: Hand sanitizer (limit 2 one gallons jugs per business) 
Yes
No
Required 13.
PPE Request: Lysol wipes (limit 2 canisters per business)
Yes
No
Required 14.
PPE Request: Disinfectant concentrate (limit 2 one gallon jugs)
Yes
No
Required 15.
Does your restaurant currently have propane heater(s)?
Yes
No
Required 16.
If you answered yes to currently having propane heater(s), would your business benefit from the Chamber providing propane refills for your heaters? If yes, how many would you need (elaborate on how many your business goes through on a daily or weekly basis)?
 

50 characters left.
Required 17.
Does your restaurant currently have outside seating covering, such as tents? 
Yes
No
Required 18.
PPE Request (CHECK-IN/CHECK-OUT ONLY): Would your business benefit from the Chamber providing outside seating covering, such as tents or tarps? If yes, how many would you business need?
 

50 characters left.
19.
Please leave any comments or additional requests below if needed:
 

50 characters left.