For more information, please contact us at: Greek Farms International, LLC • 21-77 31st Street, Astoria, NY 11105 Phone: 718-932-9293 • Fax: 718-932-3595 Email: info@terramedi.com Are you a Distributor Retailer Consumer? Would you like Terra Medi to send you an informational kit? Yes No Contact Name: Company Name: Street Address: City: State: Choose a State Outside US / Canada Alabama Alaska Alberta American Samoa Arizona Arkansas Armed Forces Americas Armed Forces Europe Armed Forces Pacific British Columbia California Colorado Connecticut Delaware District Of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northern Mariana Is Northwest Territories Nova Scotia Ohio Oklahoma Ontario Oregon Palau Pennsylvania Prince Edward Island Province du Quebec Puerto Rico Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon Territory Country: Zip Code/Postal Code: Phone Number: Fax Number: Email Address: Web Address: What is the best time to contact you? Where did you hear about Terra Medi Products? Comments: To learn more about the benefits of becoming an exclusive Terra Medi Distributor, please ask your sales representative for a detailed sales kit.