Small Business, Non-Profit and Faith-Based Organizations Supply Request Form
This form should only be used by small businesses, non-profit and faith-based organizations that have 20 or less employees and are physically located within Suffolk County. Entities within Nassau County should contact Nassau County OEM. Medical providers in need of supplies should continue to utilize the request form here.
Submission of this form is an agreement with Suffolk County that this business will use the Personal Protective Equipment (PPE) provided by Suffolk County only for the purpose of addressing the threat to the public health posed by Covid-19 in compliance with State Executive Orders and guidance for reopening businesses.
PPE, if provided, will be free and consist of two reusable cloth face coverings per employee and one gallon of hand sanitizer per business/organization.
Upon submission of your request form, you will receive a submission receipt via email. You will receive a separate notice of the date and time for fulfillment of your request. Supplies must be picked up at the designated location by one of the two contact individuals listed below.
If you require assistance completing this form please contact Suffolk County 311 (631-853-6311)



Secondary Contact

(Must Be A Different Person)