Are you acting in an individual capacity or representing a company/organisation?
YesNo

Please state the type of organisation you are representing? (if applicable)

Full Name of Contact Person

Requester Title/Profession

Name of institution you are representing (if applicable)

Email Address

Phone Number

City

Country

Which types of equipment are you looking for? Please tick all that apply.
N95 Respirator MasksKN95 Respirator MasksFFP1 Respirator MasksSurgical MasksOther Masks (including homemade)VentilatorsSurgical GlovesProtective GogglesFace ShieldsGownsAlcohol based sanitisation products (including wipes & disinfectants)Disposable BootiesCoverallsThermometersOther

What quantities are you looking for?

How quickly do you need the equipment?

Do you have a budget available to purchase supplies? If so please enter the budget total.
YesNo

Are you able to pre-pay before delivery?
YesNo

Do you have any Unit Price Constraints?
YesNo

Are there any specific procurement requirements? (if applicable)

Are you interested in taking part in an aggregated order as a member of a buyer coalition?
YesNo

Any other comments or information?

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