• N-95 Eligibility Form

    N-95 Eligibility Form

    Payment will be taken after approval and upon follow up contact from Ladd Safety. If an order goes unfulfilled, all funds will be refunded. Please review all questions and note those that are required. Our goal is to source small, private practices with 3M N-95 masks at a pre-pandemic market rate. Filling out this form is not a guarantee of order delivery, as 3M ultimately decides necessity. You will be contacted by a representative from Memphis Medical Foundation or Ladd Safety regarding the status of your order and to process a purchase order. NO FOLLOW UP CALLS PLEASE. 3M is only providing status updates in the event of an approval.
  •  -

  • 3M 8210 Non-Valved Mask
  • 3M 8511 Valved Mask
  • Should be Empty: