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COVID-19 Rapid Test Kits Survey
Business Name
*
Primary Contact (First and Last Name)
*
Business Address
*
City
*
State
*
Email
*
Phone
*
Total Full-Time Employees
*
Total Part-Time Employees
*
I am interested in having my business considered for receiving the rapid test kits.
*
Yes
I have reviewed and understand the requirements for participation.
*
Yes
