Condom Order Form IOWA

Condoms TO-GO Order Form- IOWA

Shipping to Iowa through USPS order may take up to five business days to arrive. Please fill out required information for shipping. Need condoms now? check out https://www.myiacondoms.org/condom-locator
Full Name (no personal information is stored beyond mailing needs)*

First NameLast Name
Age
for demographics
Gender
for demographics
Race/Ethnicity
for demographics
Address (Note: We do not send condoms to states outside of Iowa)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Enter City and State: (Note: We do not send condoms to states outside of Iowa)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Zipcode*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail*
Quantities are set to packs of 10 condoms, with 30 condoms max. Condoms are always free for every order. Every package will be sent in a discreet envelope. Internal Condoms come in packs of 5.

For any variations requests please indicate in "special instructions" (ex. 30 Trojan KYNG, 15 Trojan/15 ONE)

For large order inquiries or Businesses/Organizations, please contact our Condom Distributor at jos@nap.org or 712-435-0917
Due to large order volume please give up to a week to arrive.
Condom Special Instructions
ex. 10 regular / 20 Latex free; 30 Rough ONE Legend
Condoms*
Dental Dams come in packs of 4 (one of each flavor). Lubricant comes in value-sized tubes limit of 5 per package (Please indicate any extra requests in special instructions.)
Dental Dams/ Lube special instructions
Ex. all strawberry Dental Dams; no mint Dental Dams
This form is for Iowa residents only. If you are a Nebraska resident, order from our Nebraska order form, otherwise your request will not be fulfilled.
Email Validator*
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Condoms TO-GO Order Form- IOWA