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.)  
   		  NDQuits Pregnancy Brochure 
(Click on image to open and print.)		     ND Smoke-Free Law 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.)
               
Cancer    
(Click on image to open and print.)		            
               
Posters              
NDQuits for Tearoffs (8.5x11)   
(2 Tearoff Pads per Poster)		    Use NDQuits (8.5x11)   
(Click on image to open and print.)
     
               
Other      
20-Minutes foldover card (3x2.5)         Wallet Card         Tearoff Sheet   
(limit of 2 pads per NDQuits for Tearoffs Poster)
                
Tobacco-Free Campus Window Cling     
   NDQuits Pocket Guide     

One full sheet of paper folded to
easily fit into a shirt pocket.  
(Click on image to open and print.)		       
      Great tool for healthcare providers to understand NDQuits services. Also includes information on Nicotine Replacement Therapy (NRT) dosing, reducing nicotine withdrawal symptoms, and comparing the daily costs of NRT to smoking a pack a day.       
               
Smoke Free Vehicle sticker (1.5” x 3”)
     		   Double-sided Stick-on No Smoking Sign       
               

                                     

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 Tobacco Prevention & Control Program at 800.280.5512 or 701.328.3398.