Tobacco Prevention and Control Program
Order Form

Quit Now Logo             

If you have questions call 1.800.280.5512.

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

 

Quitline Items:

Posters

Journey poster - female (8.5 x 11)     

Journey poster - male (8.5 x 11)       

Make a Healthy Decision stand-up poster - female (8.5 x 11)     

   Easels     

   Make a Healthy Decision stand-up poster - male (8.5 x 11)     

   Easels     

Quitline tear-off sheets for stand-up posters (includes 2 tear-off pads)  

          Pregnant woman poster (8.5 x 11)     

American Indian Mom/Daughter poster (11 x14)    

   Helping North Dakotans Quit poster (8.5 x11)    

Patient Information palm card (2.75 x 11)             

       Mother with infant    

      Blue-collar worker     

     Young couple    

       College-age couple    

Mother with Infant (American Indian)    

  American Indian Man     

Pregnant mother     

Promotional cards (3 x 4) 

          Elderly couple    

       Older cowboy (spit tobacco)     

 

QuitNet Items:

   You Decide Where poster (8.5 x 11)    

Combination Items:

                              20-Minutes foldover card (3 x 2.5)    

  Quitline/QuitNet brochure (tri-fold brochure - 9 x 12)     

Quitline/Quitnet wallet card (Take Charge.) (3.5 x 2.5)     
                                                                           (max. 250)

                Get Started Quitting poster (8.5 x 11)     

                                        Call In or Log On poster (8.5 x 11)     

                              Freedom From Commercial Tobacco Poster (8.5 x 11)      

Patient Information palm card (2.75 x 11)

    Blue-collar worker    

     Mother with infant     

           Young Couple     

    Middle-age Couple    

        Mother with infant (American Indian)    

 American Indian Man     

        Pregnant Mother     

       Freedom From Commercial Tobacco     

Other:

    SIDS Poster     

 

                                        Date:   

                                      Name:    

Business/Health Agency Name:    

                       Mailing Address:   

                                        City:      State:   Zip:        

                       Phone Number:        

                         Email Address:      

 

Type of health-care agency (check one or more)

Public Health:       Hospital: 
Pharmacy:   

Doctor's Office: 

OB/GYN Office:    Dentist: 
Counselor:  Mental Health/Substance Abuse Treatment: 

Respiratory Care: 

Home Health Care: 
Other (describe): 

If you experience trouble submitting the form online, you can call your order in to the North Dakota Division of Chronic Disease at 1.800.280.5512 or 1.701.328.3138.