By placing this order, I agree to each of the following:
Do not complete this request form unless a Condom Distribution Application has already been submitted and you have received authorization to make Condom requests. You must specify below the e-mail address and organization address that was provided on the Condom Application.
Indicate your order on the form below. The quantity specified should be the number of cases you would like for each item.
NOTICE: We make no assurances that we have the itemized products in stock. We reserve the right to:
Please allow approximately 4-6 weeks for this order to be filled.
1350 NW 14th Street, Suite 202B
Miami, FL 33125
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