GOMOJO Partnership Form

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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.

For 20,000 points what is *

20000 points

For 20,000 points where is this painting hanging in Downtown Las Vegas? *

20000 points

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?

Check or Money Order

Credit Card

Required

To pay by credit card please click link below and follow to bottom of page for "Buy Now" Paypal Button

PREVENTION IS CARE

We will contact you upon payment for you choice of design and logo options.

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