Amazon Business COVID-19 Supplies Store: Member Association Onboarding

1. Amazon has created a site for medical supplies that are in critically short supply, including PPE. The site currently is only allowing hospitals and governmental agencies to purchase. Once Amazon increases its supply, they will expand the types of medical facilities that can purchase products. AAFP is working to collect information on our members that wish to purchase medical equipment so they can be whitelisted on the Amazon site. The following information is the information Amazon has asked us to collect.

If you wish to be able to purchase in the future, please fill out this form. We will be sharing this information with Amazon for the purpose of placing your organization on the whitelist.

Member Organization Name

Street Address Line 1

Street Address Line 2

City

State

Zip

Point of Contact (PoC) First Name

PoC Last Name

PoC AAFP Member ID Number This question requires a valid number format.

PoC Job Title

PoC Email Address

PoC Phone Number

Number of Employees This question requires a valid number format.

Number of Facilities This question requires a valid number format.