Responsible Tobacco Retailer Tobacco 21 Materials Order Form
Please complete this form to request existing Responsible Tobacco Retailer campaign materials developed by the Center for Tobacco Prevention and Control (CTPC), within the Maryland Department of Health.

Materials may be shipped via USPS or UPS. Special delivery instructions should be noted in the field "Special Delivery Instructions." Materials cannot be shipped to PO Boxes. Please provide the exact shipping address in the fields below.

Please allow 2-4 weeks for delivery.

Contact mdh.notobaccosalestominors@maryland.gov with any questions.
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Name, Title/Role *
(example: John Doe, Project Coordinator)
Organization *
(example: Maryland Department of Health)
Street Address *
(example: 123 Anywhere St.)
City *
(example: Town )
State *
(example: MD)
Zip Code *
(example: 12345)
County
Clear selection
Special Delivery Instructions
Phone Number *
(example: 123-456-7890)
E-mail Address *
Materials *
Select the product(s) and quantities you would like to order. In addition to the items listed below, CTPC has additional, updated materials available for print and download at www.NoTobaccoSalestoMinors.com <health.maryland.gov/notobaccosalestominors>.
No thanks
1
5
10
20
50
100
Other
Window Cling (8.5"x8.5")
Poster (8.5"x11")
Tobacco Product Guide
Quick Reference Guide
21 or None Packet (Window cling, poster, 2020 Retailer updates, Quick Reference Guide)
Other
If "Other" enter the items and quantities here
*Based on availability
Submit
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