Lewis Laboratories International, Ltd. Store Sample Request

Sample Request Form For Retail Stores For brick and mortar Health Food Retail Stores, kindly print this form and mail or fax your State Tax Resale Certificate, together with all pertinent business information to us at: 203-454-0329. We will then send free taste samples, price sheet and terms and conditions. Mail this form and your State Tax Resale Certificate to: Lewis Laboratories International Ltd. P.O. Box 373 Southport, CT 06890 (800) 243-6020 or fax to: (203) 454-0329

STORE NAME

CONTACT PERSON

STREET			STE. NUMBER

CITY	STATE	ZIP	PHONE

EMAIL

Available Taste Samples

Place amount you would like to order in the box

Brewer's Yeast	RDA
Fiber Yeast	NEW! Staminex with Stevia Extract
Fabulous Fiber
The Lecithin from Lewis Labs
Over 40 Unflavored

All taste samples are shipped with informational literature attached.
Directions for use, serving size and supplement facts are included.

Please send information on Dog Formula and Cat Formula.

We would like a counter display filled with samples.

Please retain display box for future use.

If interested in carrying Lewis Laboratories' products, we can recommend a distributor who carries our products or we can supply you with our retail or professional prices upon request.

SELECT NUTRITION (DIVISION OF UNITED NATURAL FOODS) CARRIES THE ENTIRE LINE OF LEWIS LABORATORIES PRODUCTS

DISCLAIMER

Lewis Laboratories International, Ltd., does not sell directly to other web-site/internet companies and, therefore, does not guarantee any products sold by any such companies.