Rapid Tests Order Form | Winnipeg Chamber of Commerce

Please complete this order form if you are a Manitoba business requesting COVID-19 rapid test kits.

SECTION 1: BUSINESS INFORMATION
Name of Business*
Are you a Winnipeg Chamber member?*
- Yes
- No
If you are an existing MDA customer and know your customer reference number, please list it here.
Requester Name*
First Last
Shipping Address*
Street Address Address Line 2 City Province Postal Code
Phone*
Email*
If you require tests for employees, please provide the total number of employees within your organization.
Please note: the number of test kits issued is based on the following factors: • 10% of the total number of persons indicated above (unless you inform us that you are experiencing an outbreak and require more) • Supply availability • Shipping frequency (generally monthly) • Current public health orders and guidance on test eligibility Please note: Organizations with 200 or more employees may choose to apply for rapid test kits directly with the Federal government. For details and to place an order, please visit https://www.canada.ca/en/public-health/services/diseases/coronavirus-disease-covid-19/testing-screening-contact-tracing/rapid-tests-employees.html
If you require tests for vulnerable populations you serve, please provide the total number of clients/patients/residents you serve.

Please note: the number of test kits issued is based on the following factors: • 10% of the total number of persons indicated above (unless you inform us that you are experiencing an outbreak and require more) • Supply availability • Shipping frequency (generally monthly) • Current public health orders and guidance on test eligibility
Declaration*
I have read and confirmed the following:
Checking this box confirms that all the information provided is true and accurate. I confirm that falsifying information may result in my organization no longer being able to access rapid tests through The Winnipeg Chamber's Rapid Tests Program.

I understand that the rapid tests are only for the use of employees and/or the vulnerable population you serve and are not for re-sale.

If you are having trouble submitting the above form, please email [email protected]

Please complete this order form if you are a Manitoba business requesting COVID-19 rapid test kits.

SECTION 1: BUSINESS INFORMATION

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