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We ship samples via FedEx ground and cannot guarantee specific arrival dates. Because we are unaware of personal requirements and cannot provide dietary counseling or medical advice Ener-G Foods cannot be responsible for the improper selection and use of its products. Consequently we urge physicians and/or dietitian consultation for guidance concerning dietary needs. st 5960 1 Ave. S. Seattle WA 98108 Phone 206-767-3928 Toll free 1-800-331-5222 Fax 206-764-3398 www. For Internal Office Use Only Date Received Ener-G Foods Inc. Reference Ship Date Ener-G Samples Request Support Group Meeting Sample Type Walk/Fundraiser Event/Picnic/Camp Stores/Retail/Brokers Hospital/Doctor Assistance Other Gluten Free-Celiac Diet Restrictions Autism PKU/Low Protein Allergy Specify Organization Contact Name Organization Address Phone City State Zip Code Fax Email Shipping Address Phone Date to receive samples by of samples/attendees/etc. Ener-G Catalog Additional Information How many 3-fold Brochure Specific Ener-G product requests e.g. Tapioca Bread Wylde Pretzels etc. Send the samples request form to any of the following Fax 206-764-3398 Attn Nermina Jendruh 5960 1st. Ave. S* Seattle WA 98108 Email nermina*jendruh ener-g. com Note Ener-G Foods only provides samples and will not honor any monetary fees associated with this donation* To ensure that your request is processed on time we require that all requests be submitted no later than 4 WEEKS from the date of the event. We ship samples via FedEx ground and cannot guarantee specific arrival dates. Because we are unaware of personal requirements and cannot provide dietary counseling or medical advice Ener-G Foods cannot be responsible for the improper selection and use of its products. Consequently we urge physicians and/or dietitian consultation for guidance concerning dietary needs. st 5960 1 Ave. S* Seattle WA 98108 Phone 206-767-3928 Toll free 1-800-331-5222 Fax 206-764-3398 www. Ave. S* Seattle WA 98108 Email nermina*jendruh ener-g. com Note Ener-G Foods only provides samples and will not honor any monetary fees associated with this donation* To ensure that your request is processed on time we require that all requests be submitted no later than 4 WEEKS from the date of the event. We ship samples via FedEx ground and cannot guarantee specific arrival dates. Because we are unaware of personal requirements and cannot provide dietary counseling or medical advice Ener-G Foods cannot be responsible for the improper selection and use of its products. We ship samples via FedEx ground and cannot guarantee specific arrival dates. Because we are unaware of personal requirements and cannot provide dietary counseling or medical advice Ener-G Foods cannot be responsible for the improper selection and use of its products. Consequently we urge physicians and/or dietitian consultation for guidance concerning dietary needs. Consequently we urge physicians and/or dietitian consultation for guidance concerning dietary needs. st 5960 1 Ave. S* Seattle WA 98108 Phone 206-767-3928 Toll free 1-800-331-5222 Fax 206-764-3398 www.

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