Wallet Card Order Form

Interested in helping the smokers you serve quit smoking? Great! So are we. Fill out the order form below to receive free wallet cards you can distribute to those in your community that smoke and are looking to quit.

The wallet card provides empathetic messaging, encouraging smokers to re-learn their lives without cigarettes. It also provides a check list that smokers can use to identify and remember their triggers. Most importantly the card is an easy reminder of where smokers can get a free quit plan from EX - at BecomeAnEX.org.

Thanks for your interest in ordering EX wallet cards!

PLEASE NOTE: Wallet Cards can be shipped to an address within the United States ONLY.

FRONT of Wallet Card

BACK of Wallet Card

Quantity of wallet cards needed (Minimum: 200 - Maximum: 5,000. Packaged in sets of 200. Please order in multiples of 200, e.g., 200, 400, 600, etc.): *

We're interested in knowing how you plan on using the wallet cards. Please take a minute and let us know your plans for distribution. *

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How did you learn about the Free EX Wallet Card opportunity?

Name: *

Title: *

Name of Organization: *

Type of Organization: *

Organization Address (U.S. address only):
(Street) *

(City) *

(State) *

(Zip Code - only first five digits) *

Email: *

Phone: *

(Type of phone number provided)

Shipping Address (if different than Organization Address):
(Street)

(City)

(State)

(Zip Code - only first five digits)

Note/Special Requests:

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For assistance please contact Virginia Lockmuller at 202-454-5793, or vlockmuller@legacyforhealth.org.

Processing and shipping of your order takes 3 - 4 weeks.