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.
You will receive a confirmation notice from The Florida Department of Health in Miami-Dade Condom Program after placing your request. If you have any further questions regarding this program, please contact Erika Coello at Erika.Coello@flhealth.gov. Thank you!
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 3-4 weeks for this order to be filled.
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