Teaching Tools Order Form
** Shipping time for orders may be as long as 14 business days. Please note below if you need your order by a particular date.**

Please complete this form to order Teaching Tools materials. Once this form is submitted, you will receive an invoice with additional instructions for submitting payment. 

For each item, please select the quantity you would like to order. Please select "0" for items you do not wish to purchase. 

For questions or additional information, contact Liana Cunningham at Liana.Cunningham@ppsne.org or 203-752-2840. If you are interested in purchasing a quantity that is larger than the maximum quantity listed for a particular item, please contact Liana to ensure we can accommodate your request. 
Sign in to Google to save your progress. Learn more
Email *
Contraception & Safer Sex Methods Demonstration Kit- $155
Contraception & Safer Sex Methods Demonstration Kit 
How many would you like to order?
 *
Condom Demonstrators- $18
Condom Demonstrators
How many would you like to order?
 *
Reproductive Anatomy Flip Chart- $155
Reproductive Anatomy Flip Chart
How many would you like to order?
 *
Any special requests or things you'd like for us to know about your order? Shipping, especially for large orders, may be as a long as 14 business days. If you need your order by a particular date, please note that here. 
Billing Information
Please complete the following information for payment. If you will be paying by credit card, please make sure the name and zip code entered below match the name and zip code for the card. 
Name *
Organization (if applicable)
Address *
City, State, and Zip Code *
Phone Number *
E-Mail Address *
Shipping Address
Please complete the following information for where you would like the order shipped. If the shipping address is the same as the billing address, you can leave the fields blank. 
Name
Organization (if applicable)
Address
City, State, and Zip Code
Phone Number
E-Mail Address
Payment Information
Please select your payment method. Orders paid by check/PO receive a 3% discount off the total price and orders paid by bank payment (ACH) receive a 2% discount. Orders paid by credit card or bank payment (ACH) will be shipped once you submit payment (via the invoice you receive). Orders paid by check or PO will be sent upon receipt of check or purchase order. 
Payment Method *
Required
Thank you for your order!
Once your form is submitted, you will receive an invoice within 3 business days. Orders are not shipped until payment has been processed or purchase order has been received. 
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of PPLM. Report Abuse
Google Forms