Agency Contact Information *Please note that we only supply to agencies or organizations. Please fill out your organization's contact information and order request using the form below. If you have any questions, please call us at 407-858-1400First Name(Required) Last Name(Required) Title Organization(Required) Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone(Required)Extension Fax Number: Email Address(Required) Order Requests Indicate your order on the form below. The quantity specified should be the number of cases you would like for each item. - Male Condoms - Female Condoms - Other Latex Barriers - Lubricants NOTICE: We make no assurances that we have the itemized products in stock. We reserve the right to: - Deny any order in whole or in part; - Adjust the quantity of orders; and - Substitute items. Male CondomsONE Legends 1,000 per case:01234567891011121314151617181920304050607080Lifestyles SKYN (latex free) 1,000 per case:01234567891011121314151617181920304050607080ONE Classic 1,000 per case:01234567891011121314151617181920304050607080ONE Flavors 1,000 per case:01234567891011121314151617181920304050607080Trojan ENZ 1,000 per case:01234567891011121314151617181920304050607080Trojan Magnum 1,000 per case:01234567891011121314151617181920304050607080Atlas Black 1,000 per case:01234567891011121314151617181920304050607080Female CondomsFC2 Female Condom 100 per bag:01234567891011121314151617181920304050607080Other Latex BarriersSheer Glyde Dental Dams 100 per case:01234567891011121314151617181920304050607080LubricantsONE Move – Silicone-based 500 per case:01234567891011121314151617181920304050607080ONE Oasis – Water-based 500 per case:01234567891011121314151617181920304050607080Consent(Required) I agree to the terms of use.(Required)- All items ordered through this program must be provided FREE of charge. - All of these items will be distributed solely within Central Florida - The staff, volunteers and other agents of my organization may not knowingly furnish these items for re-distribution outside of Central Florida. - I will cooperate with staff from the Florida Department of Health in evaluating this program.