Condom Mailer Order Form
Orders are fulfilled with latex condoms. If you have a latex allergy or sensitivity, please contact your local clinic (found on for non-latex options. For alternative barrier methods such as dental dams please contact

-Condom mailers are only available to residents of the State of Wyoming
-Verifiable residential and PO Box addresses only
-Additional questions may be directed to:

Age *
Gender *
Why I don't buy condoms... *
First Name *
Your answer
Last Name *
Your answer
Street Address or PO Box *
Your answer
City *
Your answer
State *
Zip Code *
Your answer
County *
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