Are you submitting an order for your home or a place of business? Please select Home Business

How many adults and children are there in your household?

Adults 18+ Please enter a number between 0 and 10.

Children 0–17 Please enter a number between 0 and 10.

Business name

How many employees are working at this location? Please enter only numbers.

First name

Last name

Street address

City

Postal code Please enter a valid postal code. Your home or business is not within the eligible zone of the Pickering or Darlington stations. There is no need for you to have KI pills on hand.

Phone number Please enter only numbers.

Email address Please enter a valid email address.

I am 18 years of age or older.

Reason for your order Please select I have not received any tablets I did not receive enough tablets during the original distribution The tablets I was given are damaged or lost Other

Please explain your reason