Supply Request Form

Supply Request Form
Accessibility

The State of Colorado is committed to providing equitable access to our services to all Coloradans. View the Accessibility, Interpretation & Translation Support page.

To report digital accessibility barriers or request accommodations, complete the CDPS Issue Reporting, Accommodation and Translation Request Webform and/or email: cdps.ovpconnect@state.co.us.
Name*

First NameLast Name
Email*
example@example.com
Agency Name*
Important Information

Requests will be fulfilled in the order they are received, until supplies run out.

Supplies must be picked up at the OVP office. The pickup address is: 700 Kipling St. Lakewood, CO 80215.

You must order at least 4 boxes of masks in order for our office to ship them to you.
Are you able to pick-up the supplies?*

YesNo
Shipping Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please enter the number of BOXES/BOTTLES you are requesting.

1 Box of N95 Masks = 50 masks

1 Bottle of Hand Sanitizer = 8.5 ounces
Masks
Number of boxes being requested (50 per box)
Hand Sanitizer
Number of bottles being requested (8.5 ounces per bottle)
For questions: cdps.ovpconnect@state.co.us.
Should be Empty: