P.O. Box 159,
Exeter, CA 93221-0159 USA
Garuda Email
+1 559-594-4380
FAX: +1 559-594-4689


Please Note: This form is to be used only by qualified manufacturers and distributors of foods, nutraceuticals, beverages cosmeceuticals and pharmaceuticals. For all consumer inquiries, please use our


Requests for Samples
Samples may only be obtained by faxing your request on your official company letterhead / stationery to 1-559-594-4689

* = Required Field
*First Name: *Last Name(surname):
Title / Position: Job Function:
*Company Name:
*Street Address:
*City: State or Province:
*Country: Postal Code:
*Email Address: Company website:
*Telephone: Fax:
In U.S.A. please include area code. If outside U.S.A. please include city and country codes

How would you like to be contacted? (check all that apply):
Email Fax
Air Mail Telephone

What is your company type? (check all that apply):
Trading Company Bakery Product Manufacturer
Importer / Distributor Snack Foods Manufacturer
Commissioned Agent Healthy or Dietetic Foods Manufacturer
Consultant Cosmetics Manufacturer
Government Office Dietary / Nutritional Supplement Manufacturer
Beverage Manufacturer Pharmaceuticals Manufacturer
Dairy Products Manufacturer Other Manufacturer (please list below)
If "Other" checked, please list:


Product(s) for which you would like information: Your Product Application:
Acesulfame-K - ACEK
Aloe Vera 10X Liquid Concentrate (Cosmetic) - AVC10XC
Aloe Vera 10X Liquid Concentrate (Food Grade) - AVC10XFR
Aloe Vera Gel Freeze-Dried Powder, 200:1 - Ingredient - Raw Material - AVGFDPW200
Aloe Vera Gel Spray-Dried Powder, 200:1 Ingredient - Raw Material - AVGSDPW200
Aloe Vera Oil Extract - AVOIL
B-CAN® Soluble Oat Fiber (70% oat beta-glucan) Ingredient - Raw Material - OGLUCAN70
Chaga Sclerotium Extract 1:1 - Certified Organic - CHAGMUSPW-O
Chaga Sclerotium Extract 8:1 - CHAGEXT8
Chaga Sclerotium Extract 8:1 - Certified Organic - CHAGEXT8-O
Cordyceps Mushroom Extract 1:1 - Certified Organic - CORDYCEPSMU-O
Cordyceps Mushroom Extract 10:1 - Certified Organic - CORDYCEPSEXT10-O
Cordyceps Mycelia Powder Cs-4 - CRDMYCPW
COWCIUM Natural Milk Calcium 24 - MILCAL24
COWCIUM Natural Milk Calcium FG - MILKCALFG
Golden Light Cane Sugar, Certified Organic - GDLCSG-O
Heli-FOS™ Jerusalem Artichoke Flour, Certified Organic Ingredient - Raw Material - JAFBULKKG-O
Hericium (Hericium erinaceus) Mushroom Powder, Certified Organic - HERMUPW-O
High Pol Sugar, Certified Organic - HIPLSG-O
LesstanoL Octacosanol 95 - OCTA-95
LesstanoL Policosanol 60 (Polycosanol) Raw Material - OCTA-60
LesstanoL® Octacosanol GF - OCTA-GF
Maitake Mushroom Bio-enhanced, Certified Organic - MAIMUPWE-O
Maitake Mushroom Extract 4:1, Certified Organic - MAIEXT4-O
Maitake Mushroom Extract Standardized, Certified Organic - MAIEXT10-O
Oyster (Pleurotus ostreatus) Mushroom Powder Bio-enhanced, Certified Organic - OYSMUPWE-O
Oyster (Pleurotus ostreatus) Mushroom Extract, Certified Organic - OYSEXT4-O
PleSance Agave Syrup, Dark Premium, Certified Organic - AGAVESYRDP-O
PleSance Agave Syrup, Light Premium, Certified Organic - AGAVESYRLP-O
PleSance Agave Syrup, Light Standard, Certified Organic - AGAVESYRLS-O
PleSance Agave Syrup, Raw Standard, Certified Organic - AGAVESYRRS-O
PleSance Coconut Sugar (Cocos nucifera), Granular, Certified Organic - CNPSG-O
PleSance Stevia Extract Powder - STEVIARAPW1
Poria (Wolfiporia extensa) Sclerotium Powder - PORIMUSPW
Proti-GERM™ Defatted Wheat Germ DTC - DWGERMDTC
Proti-GERM™ Defatted Wheat Germ DTC-CS - DWGERMDTC-CS
Proti-GERM™ Defatted Wheat Germ LTG - DWGERMLTG
Proti-GERM™ Defatted Wheat Germ MTF - DWGERMMTF
Proti-GERM™ Defatted Wheat Germ MTFG - DWGERMMTFG
Proti-GERM™ Defatted Wheat Germ RC - DWGERMRC
Proti-GERM™ Defatted Wheat Germ RF - DWGERMRF
PuntiaVera® Certified Organic Nopal Cactus Cladodes Powder (Opuntia ficus indica) Ingredient - Raw Material - NOFIPM120-O
Quillaja (quillaia) Refined Saponins Powder - 70% - QUSAPR70
Quillaja (quillaia) Saponaria Extract Powder, 100% Food Grade Ingredient -
Raw Material - QUEXT100
Red Reishi Mushroom Extract 16:1, Certified Organic (Ganoderma lucidum) - REIEXT16-O
Reishi (Ganoderma lucidum) Mushroom powder bio-enhanced, Certified Organic - REIMUSPWE-O
Reishi (Ganoderma lucidum) Mushroom Extract 4:1 - REIEXT4
SelenoExcell High Selenium Yeast Powder Raw Material - SELENOEXCELL
Shiitake (Lentinula edodes) Mushroom Bio-enhanced, Certified Organic - SHIMUSPWE-O
Shiitake (Lentinula edodes) Mushroom Extract 4:1, Certified Organic - SHIEXT4-O
Tremella (Tremella fuciformis) Mushroom Powder, Certified Organic - TREMUPW-O
Turkey Tail Mushroom Extract 1:1 - Certified Organic - CORIMUPW-O
Turkey Tail Mushroom Extract 8:1 - Certified Organic - COREXT8-O
Yucca Schidigera Extract NP Raw Material (Food Grade) - YUCEXTNP
Züeit® Sucralose - SUCRALOSE

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