Tobacco Prevention and Control Program
Order Form

             

If you have questions call 800.280.5512.

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.

 
Brochure               
Brochure                 
               
Patient Information palm card (2.75 x 11)               
Mother with Child   
 
   Pregnant Woman     Young Couple
Blue-collar Worker
  Older Couple   
  Mother with Child (American Indian) 
Male with Child (American Indian)     
   Spanish Language Female    SpanishFemale
   Spanish Language Male    SpanishMale
Air Force      Army National Guard      College Student   
               
Wallet Card              
NDQuits Wallet card                 
               
Posters              
Many Ways (11x17)      NDQuits Key 
(Each poster comes with 2 tear off pads)		      
               
Other      
Find Your Freedom (2.75 x 11)      Find Your Freedom (8.5 x 11)    20-Minutes foldover card (3 x 2.5)   
SIDS Poster    Tear Off Pads      Easels      
               

                                     

Date:   

Name:    

Business/Health Agency Name:    

Mailing Address:   

City:      State:   Zip:        

Phone Number:        

Email:    

 
               
 
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 701.328.2333.