New York State Infant Mortality
Collaborative Improvement and Innovation Network - (CoIIN)
Safe Sleep Materials Order Form
Instructions for ordering bulk materials:
 Materials are available free of charge to New York State providers.
 Complete the order form below. Circle only one quantity per publication.
 Complete the address label below. Please type or print clearly.
 All orders must include a street address. Orders cannot be delivered to Post Office boxes.
 Allow three to four weeks for delivery.
Questions about an item? Call: (518) 474-5027 or e-mail [email protected]
You may:
 Mail orders to: NYSDOH Distribution Center, P.O. Box 343, Guilderland, New York 12084
 Email orders to: [email protected]; phone orders to: (518) 675-3004
Title
Publication Number
Quantity (Circle One)
ABCs of Safe Sleep Brochure (English)
ABCs of Safe Sleep Brochure (Spanish)
ABCs of Safe Sleep Brochure (Haitian-Creole)
ABCs of Safe Sleep Brochure (Italian)
ABCs of Safe Sleep Brochure (Korean)
ABCs of Safe Sleep Brochure (Russian)
ABCs of Safe Sleep Brochure (Chinese)
ABCs of Safe Sleep Magnet (English)
ABCs of Safe Sleep Magnet (Spanish)
ABCs of Safe Sleep Cling (English)
ABCs of Safe Sleep Cling (Spanish)
ABCs of Safe Sleep 11X17 Poster (English)
ABCs of Safe Sleep Poster 11X17 (Spanish)
ABCs of Safe Sleep Crib Card (English)
Address Label (please print or type)
Name:
Organization:
Street Address:
City:
State:
Telephone:
Email:
9/27/2016
0672
0673
0674
0675
0676
0677
0678
0679
0683
0680
0684
0671
0669
0682
Zip:
25
25
5
5
5
5
5
5
50
50
10
10
10
10
10
10
100
100
15
15
15
15
15
15
5
10
15
5
5
5
10
10
10
15
15
15