GOMOJO Partnership Form
Sign in to Google to save your progress. Learn more
GOMOJO CONDOM DISTRIBUTION PROGRAM
Our goal is to empower people to USE the condoms that are provided for the public by the United States Federal Government.  When you support or facilitate the purchase of MOJO Bags and distribute them to your people, GOMOJO will take care of the rest.  We will provide continuous support of filling and refilling the MOJO Condom Key Chain with condoms.  
Contact Name *
Company Name *
Company Address *
Company Street address
City and State *
City, State ZIP Code
Phone *
Email *
Partnership Level *
Choose sponsorship level you would like to participate.
Dollar Donation Level to donate MOJO LIFESAVER Condom Keychain
Choose dollar amount you would like to donate. We will donate correspondent number of MOJO LIFESAVER to the Downtown Las Vegas Community
Donation limit
Enter the donation amount
Payment option *
How would you like to pay?
Required
To pay by credit card please click link below and follow to bottom of page for  "Buy Now" Paypal Button
We will contact you upon payment for you choice of design and logo options.
Enter best way to contact below.
PREVENTION IS CARE
PREVENTION IS CARE #GOMOJO
Submit
Clear form
Never submit passwords through Google Forms.
GoogleForms
This content is neither created nor endorsed by Google.