Condom Distribution Program

This request form is for local businesses, organizations, or individuals who would like to request safer sex supplies to distribute to community members. Please fill out the form below and allow one week for a SHAG staff member to reach out for bulk supply order confirmation. 

Indicates required field
Are you with a business or organization?
Type of Business Submitting Request
Types of Safer Sex Supplies Being Requested
This question is for testing whether or not you are a human
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