Riverton Business Mask Request Form

Businesses licensed commercially in Riverton are eligible to receive 50 or 100 free face masks from Riverton City.

Business licensed under the home-based / simple classification are not eligible to participate at this time.

The goal of this program is to provide businesses with a stock of face coverings they can offer to customers who enter their premises without a face covering so they don't have to be turned away.

NOTE: Provided masks could be cloth coverings or disposable medical masks, or a combination of both.

Business Name: *

Business Contact First Name *

Business Contact Last Name *

What is your role with the business? *

Phone Number *

Email Address *

Business Address *

Address Line 2

City *

State *

Zip Code *

Please select how many masks you would like for your business? *

50

100