Store Request Submission Page

Can't find our wonderful products at your favorite store. Let them know by asking them to carry them for you and their other health conscious customers.

Just complete the form below and your request will be sent to the headquarters of your favorite store.

As a thank you for taking the time to complete this form we will mail you $1.00 in coupons to use on future purchases of our products.

Which Benefit Nutrition Cereal Do You Want Your Store To Carry?		selectProtein PlusSimply FiberSimply Fiber CinnamonProtein Plus and Simply Fiber

Store Name Where You Want To Buy Our Cereal	*

Store Street Address	*

City	*

State	*

Zip Code	*

Please provide us with your contact information.
Your First Name	*

Last Name	*

Street Address	*

Apartment Number

City	*

State	*

Zip Code	*

Your Email Address

Choose A Prepared Message To Send Or Create Your Own Below		It is an important part of my daily diet for weight and cholesterol control!I never had a cereal that tastes this good and is good for my helath!I do not want to go to a second store to buy my favorite cereal. Please stock it!

If the prepared messages do not convey your needs or do justace for the passion you have for our cereals please feel free to write your personal message here.
Enter Your Personal Message To The Store Management Here

Please Enter The Black Text So We Know You Are A Real Person