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.


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   
Oilworker        Tobacco/Diabetes        Oral Health     
Wallet Card              
NDQuits Wallet card        NDQuits Wallet card           
Many Ways (11x17)      Quitting is Hard (11x17)        Find Your Freedom (11x17)
NDQuits Key (8.5x11) 
(Each poster comes with 2 tear off pads) 
  SIDS Poster (8.5x11)    Find Your Freedom (8.5x11)     
20-Minutes foldover card (3x2.5)         Tear Off Pads   
(Quantities limited to 10 and are only available with the NDQuits Key Poster)
    Provider Folder     
Tobacco Education Guide                




Business/Health Agency Name:    

Mailing Address:   

City:      State:   Zip:        

Phone Number:        


Date Needed:     

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.