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 per quarter and allow 2 to 4 weeks for delivery.

 

Brochure              
   NDQuits Brochure 
(Click on image to open and print.)
             
               
Patient Information palm card (2.75 x 11)               
NDQuits Smoking   
(Click on image to open and print.)
  NDQuits Smokeless
(Click on image to open and print.)  
  Second Hand Smoke
(Click on image to open and print.)
               
Vaping is not a safe alternative    
(Click on image to open and print.)
  My Life My Quit    
(Click on image to open and print.)   
     
               
Other      
20-Minutes foldover card (3x2.5)        Wallet Card              
                

                                     

Date:   

Name:    

Business/Health Agency Name:    

Mailing Address:  (Physical Address, No PO Boxes) 

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 Tobacco Prevention & Control Program at 800-280-5512 or 701-328-3398.