Order Form


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Order Form

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: Item # and Amount*

(Fields marked with * are required)