Prior to resupply of Diflucan®, each organization is required to submit a Progress Report describing how the previous donation was used. At the time of submitting the Progress Report, each organization will be able to submit a resupply request. The Diflucan® Partnership Program reserves the right to amend this request based on information collected on the organization’s program.
To complete a progress report and order, please download the form . Note: to read, edit and save this form, you must have Adobe Acrobat 8.0 or later. Visit http://get.adobe.com/reader/ to download the most current version.
When you have completed the form, please send it as an email attachment to email@example.com.
If you have questions, email us at firstname.lastname@example.org
Contact us by phone in South Africa:
+27 11 351 1287
In the U.S.:
+1 805 964 4767