Cedar Park Rapid COVID-19 Test Kit
RequiredRequired Question(s)
Required 1.
Please enter the information indicated below.

First Name:
Last Name:
Company Name:
Work Phone:
Email Address:
emailaddress@xyz.com
Address 1:
Address 2:
City:
State/Province
(US/Canada):
Postal Code:

Required 2.

Number of total full-time employees:

 

50 characters left.
Required 3.
I am interested in having my business considered for receiving the rapid COVID-19 test kits.
Yes
No
Required 4.

I have reviewed and understand the requirements for my business to be eligible to receive the rapid COVID-19 test kits.

Yes
No