Division of Tobacco Prevention and Control Order Form
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 brochure (tri-fold brochure - 9 x 12)
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)
Quitline tear-off sheets for stand-up posters (includes 2 tear-off pads)
Quitline wallet card (Take Charge.) (3.5 x 2.5)
Patient Information palm card (2.75 x 11)
Mother with infant
Blue-collar worker
Young couple
College-age couple
Items with 1.866.388.QUIT
Pregnant mother
Mother with infant (American Indian)
American Indian man
Posters
Pregnant woman poster (8.5 x 11)
American Indian Mom/Daughter poster (11 x14)
Helping North Dakotans Quit poster (8.5 x11)
College-age poster (8.5 x 11)
Promotional cards (3 x 4)
Young family
Couple
Young cowboy (spit tobacco)
Dad and son
Elderly couple
Older cowboy (spit tobacco)
20-Minutes foldover card (3 x 2.5)
Date:
Name:
Business/Health Agency Name:
Mailing Address:
City: State: Zip:
Phone Number:
Email Address:
Type of health-care agency (check one or more)
Doctor's Office:
Respiratory Care:
If you experience trouble submitting the form online, you can call your order in to the North Dakota Division of Tobacco Prevention and Control at 1.800.280.5512 or 1.701.328.3138.