Applicant Information Form

Applicant Information Form

Organic Certifiers, Inc. Applicant Information Form, C01-03, v10 Revised: 03/31/2023
What is the name of the farm/business?*
Provide the legal entity name.
What is the type of entity? We will later need to verify entity with a Fictitious Business Statement, Certificate of Trust/Partnership, Articles of Incorporation, or Articles of Organization, etc.*
Tell us a little bit about you and/or the operation:*
Examples: What you grow or raise, what kinds of products you make, reason for becoming certified organic, history of farm or business, etc.
What is your farm/company website?
What is your mailing address? *

Address Line 1

Address Line 2

CityState

Zip Code

The person in charge of Organic Certification at your farm/business is the Primary Contact. Provide the Primary Contact information below: *

	Primary Contact Information
Name (First & Last)
Job Title
Email Address
Phone #
Cell #
Fax #

What is the preferred method of communication? (select one)*

EmailPhone CallFaxMailed Documents & Letters
There are several types of Organic Certificates, depending on the scope of your operation. Click the links below for more information on each:
Are you applying to be an organic grower? Please select the applicable scope(s) or select "I am not applying for crop certification":*

I am not applying for crop certificationAquaponicHydroponicCropGreenhouseGrower GroupSpecialty (mushrooms, sprouts, etc.)Wild Crop
Are you applying to be an organic handler? This scope also includes brokers, brands, distributors and those who might not take physical possession of organic products. Please select the applicable scope(s) or select "I am not applying for Handler certification":*

I am not applying for Handler certificationBrand Name Owner (co-packer manufactures product)Broker (does not take possession or title of product but arranges for its sale)Commodity Handler (facilitates or otherwise arranges sale of unpackaged organic product)DistributorHandlerProcessorRetailer (grocery store, restaurant, etc.)
Are you applying to be an organic livestock operation? Please select the applicable scope(s) or select "I am not applying for Livestock certification":*

I am not applying for Livestock certificationNon-Ruminant – EggsNon-Ruminant – MeatNon-Ruminant – OtherRuminant – DairyRuminant – MeatRuminant - OtherPasture (Crop) for organic livestock *Required for ruminant livestock*

	Site Type	Site Address (street address, city, state, zip)	Management Status
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