GRAMEN NATURAL FARMS

20158 Bauer Hockley Rd

Tomball, TX 77377

I, _______________________(print name) understand that Gramen Natural Farms has Goat milk and I  SPECIFICALLY CHOOSE to purchase raw milk, fully understanding that Gramen Natural Farms is not certified to sell milk.  What I do with the milk is my own doing and I release Gramen Natural Farms and all of its affiliates of any and all liability associated with raw milk. And, I also release Gramen Natural Farms of any and all  persons that may become ill from the consumption, if any, of the raw milk that I, or any of my family members or agents, obtain from Gramen Natural Farms.

Date:  __________________________________

Printed name:__________________________________

Address: __________________________________

   __________________________________

Phone:    __________________________________

Signature: __________________________________

*Copies of this handout are available in our website at www.GramenFarms.com