Responsible Tobacco Retailer Tobacco 21 Materials Order Form
Please complete this form to request existing Responsible Tobacco Retailer campaign materials developed by the Center for Tobacco Prevention and Control (CTPC), within the Maryland Department of Health.

Materials may be shipped via USPS or UPS. Special delivery instructions should be noted in the field "Special Delivery Instructions." Materials cannot be shipped to PO Boxes. Please provide the exact shipping address in the fields below.

Please allow 2-4 weeks for delivery.

Contact with any questions.
Name/Title/Role *
(example: John Doe/Project Coordinator)
Your answer
Organization *
(example: Maryland Department of Health)
Your answer
Street Address *
(example: 123 Anywhere St.)
Your answer
City *
(example: Town )
Your answer
State *
(example: MD)
Your answer
Zip Code *
(example: 12345)
Your answer
Special Delivery Instructions
Your answer
Phone Number *
(example: 123-456-7890)
Your answer
E-mail Address *
Your answer
Materials *
Select the product(s) and quantities you would like to order. In addition to the items listed below, CTPC has the following items available for order, while supplies last: Federal/Maryland Law Sheets, Local Law Sheets, \Comprehensive State and Federal Law Guides, and Retailer Quiz Sheets. To order the above materials, please select 'Other' and enter the materials and quantities in the next question. To view the materials visit:
No thanks
Quick Reference Guide
Window Cling (8.5"x8.5") Compliant with the law
Poster (8.5"x11") Compliant with the law
Table Tent
ID Guide
Tobacco Product Guide
If "Other" enter the items and quantities here
*Based on availability
Your answer
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