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.

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

SIDS Poster (8.5x11)   		               
               
Other      
20-Minutes foldover card (3x2.5)         Tobacco Education Guide (Limit of 140)   Wallet Card   
                
Tearoff Sheet   
(limit of 2 pads per NDQuits for Tearoffs Poster)		   Easel for Posters            

                                     

Date:   

Name:    

Business/Health Agency Name:    

Mailing Address:   

City:      State:   Zip:        

Phone Number:        

Email:    

Date Needed:     

 
               
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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.