Order Form
» Page last updated on Monday, 15 February 2010
Order FREE condoms, lube & sexual health literature
The information you provide
below will be held in strict confidence but is required to secure future
funding that will enable this facility to continue. Orders will
be dispatched in unmarked envelopes
but only posted to addresses in Bedfordshire (UK).
Tick the boxes of the
item(s) you require and ensure you complete all other fields or your
order will not be processed. A maximum of 3 safer sex wallets are
supplied per order (each contains 2 condoms and 2 sachets of water based
lube).
Full Name:
Address Line 1:
(or company name)
Address Line 2:
(optional)
Town:
Postcode:
(Postal addresses in Bedfordshire
(UK) only are accepted)
email:
Phone Number:
Age:
Gender:
Ethnic Origin:
Sexuality:
Special Order Instructions:
(optional - only complete if applicable)
NO - I do not wish for you to
use my email address supplied to contact me with
additional information about services and related
projects which the Men4Men SHOP are involved with, that
you think
I would find of benefit.
(Please
note: Your email address will not be passed on to any third party
organisations)
Press the SUBMIT button once and allow up to
20 seconds for the order confirmation page to appear.
