Tobacco Prevention and Control Program
Order Form


If you have questions call 800.280.5512, select option 3.

Enter the quantity wanted for each item and the information requested below and press the "Submit" button at the bottom of the page.

Please limit quantities to 250 per item and allow 2 to 4 weeks for delivery.


NDQuits Brochure                  
Patient Information palm card (2.75 x 11)               
NDQuits Smoking        NDQuits Smokeless        
NDQuits for Tearoffs (8.5x11)   
(2 Tearoff Pads per Poster)
   Use NDQuits (8.5x11)   
  Use NDQuits (11x17)

SIDS Poster (8.5x11)   
20-Minutes foldover card (3x2.5)         Tobacco Education Guide    Wallet Card   
Tearoff Sheet   
(limit of 2 pads per NDQuits for Tearoffs Poster)
  Easel for Posters            




Business/Health Agency Name:    

Mailing Address:   

City:      State:   Zip:        

Phone Number:        


Date Needed:     

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shown on the left:

If you experience trouble submitting the form online, you can call your order in to the North Dakota Division of Chronic Disease at 800.280.5512 or 701.328.3398.