FDA Registration Form

1

Non-Disclosure Agreement* This field is required.The Disclosing Party provides FDA Compliance Services, including registration, renewal and labeling services ("Services") to production facilities, including the Recipient. These Services may include, among others, FDA facility registration and label compliance. Confidential Information: includes any information disclosed by the Disclosing Party to the Recipient, whether orally, in writing, or electronically, that is identified as confidential or should reasonably be understood as such. Information that should not be disclosed are the identity and brand name of the Disclosing Party, details of the Services, pricing, and any proprietary information.

AGREEDISAGREE

2

What types of products does your company manufacture?* This field is required.

Food

Beverage

Dietary Supplements

Wine

3

Tell us more about your production facility* This field is required.

Legal Company Name

Contact Name

Email

Facility phone (incl. country code)

4

Production Facility U.S FDA Information

FDA REGISTRATION No

COMPANY'S VAT (AFM)

FDA PIN No

DUNs Number

5

When would you like to register?* This field is required.

As soon as possible

My company is already registered

6

Provide facility information* This field is required.

Corporate Designation

Facility Address

City

State/Province/Region

Postal Code

Is your facility's address the same as your mailing address?

Google Maps Pin

7

Choose your preferred FDA Renewal Deal* This field is required.*** NOTE *** EXTRA FEE Applies for New Registrations: €250 + VAT (paid once)

1/2 year (valid for 2025): €200+VAT

1 year (valid for 2026): €395+VAT

2 years (valid for 2027): €750+VAT

8

Is this facility a subsidiary of a parent company?* This field is required.Is more than 50% of this facility owned by another company?

YESNO

9

Provide the parent company's information* This field is required.

Country

Legal Company Name

Corporate Designation

Street

City

State/Province/Region

Postal Code

Phone Number

10

Enter any trade names this facility operates under

11

Provide information for the facility's emergency contact* This field is required.

Contact Name

Job Title

Please enter your email

Please enter your phone

12

This facility handles food for* This field is required.

Human Consumption

Animal Consumption

13

Identify the product categories handled by this facility* This field is required.For Human Consumption

14

Food for Human Consumption* This field is required.Select All That Apply

15

Identify the product categories handled by this facility* This field is required.For Animal Consumption

16

Food for Animal Consumption* This field is required.Select All That Apply