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Instructions
Please fill out the form below, and click the SUBMIT button at the bottom of the screen to send us your request.



LIST OF ITEMS AND ITEM #
---------------------------------
Condom/basketball :Item # sc-b1000
Condom/football :Item # sc-f1000
Condom Rose :Item # web rose216
Condom Dynamite:Item # web dy216
Bumper Sticker :Item # web bp200
Package Deals:Item # web pkg550
Samples: Item # web sample A

You will receive confirmation within 24 hrs.






Your Name: *
Company Name or Organization: *
Address: *
City: *
State: *
Zip: *
Country: *
Phone: *
Fax:
E-mail: *
Purchase Order number: *
ORDER EXAMPLE : Web rose216 x 1 case:
*



(Fields marked with * are required)

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