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No Cost PPE Request Form for Small Businesses

  1. County of Nevada has no cost PPE available for all small businesses with 25 employees or less. To apply for hand sanitizer and masks, please complete one form per business. PPE is available while supplies last.

  2. Tell us about your business.

  3. Let us know where you would like to pick up your PPE. *

  4. How many employees do you have?*

  5. *IMPORTANT* BEFORE YOU SUBMIT

    Check the box below to receive a confirmation email. The email will originate from noreply@civicplus.com. Print, or display this confirmation email when you pick up your PPE.

  6. Leave This Blank:

  7. This field is not part of the form submission.