Face Mask Declaration of Conformity Form

Face Mask Declaration of Conformity Form
Complete this Face Mask Declaration of Conformity Form to confirm your face mask product meets all relevant standards and requirements.
Manufacturer / Company Name
Manufacturer Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Contact Person Name
First NameLast Name
Contact Email
example@example.com
Face Mask Product Name / Model
Lot or Batch Number
Type of Mask
Standards or Regulations Met
Other
Date of Declaration
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Declaration / Attestation
I hereby declare that the above-listed face mask product conforms to the stated standards and requirements.
Should be Empty: