Condom Order Form

Easy to Get, Easy to Use, Easy to be Protected!

If you reside in the Fredericksburg and surrounding areas, fill out this form and we will ship you a package of male condoms, FREE of charge!

Orders will not be filled unless this form is filled out completely.

Contact Information
How many condoms would you like to order?

**Please note: With respect to your privacy, condoms are sent in a plain envelope. Your email address will only be used for confirmation purposes, and will not be shared with any third parties. You will not be spammed.


4701 Market St., Ste. B

Fredericksburg, VA 22408

Phone: (540) 907-4555

Fax: (540) 907-4318