Service reserved for companies, not private.

1) Registered Office Information

Business name^*

Contact^*

Email^*

Phone

Address

Address ^*

City ^*

VAT number^*

Type of service requested^*

New FDA Registration € 150,00
Renewal of the FDA registration € 100,00

2) Information on production / storage facility

Business name^*

Responsible person^*

Email^*

Phone^*

Address^*

Address ^*

City ^*

Contact for emergencies^*

Preferred address for communications by regular mail^*

Head Office:
Production and / or Storage Plant

3) Product Information and Activities

List of all categories of food products (e.g. coffee, wine, pasta, etc.)^*

Type of product processing (e.g. production, packaging, labeling, storage, etc.)^*

Storage methods for the products listed above (e.g. room temperature, refrigerated, frozen, etc.)^*

4) US Agent information

Choose from one of the following options^*

Request 12 months US Agent annual service € 450,00 (go to point 5)
Request a temporary US Agent service for 2 months € 150,00 (go to point 5)
Do you have your own US Agent (fill in the data below)

US Agent name or business name

Address US AGENT

American address

City

Zip

American telephone

5) Authorizations

The undersigned authorizes the application to register, update and cancel the US Food and Drug Administration on behalf of this facility. I agree to a possible verification of the registration data and, as required by US law, to a possible inspection of the structure subject to registration by the US FDA. Authorize disclosure of property registration information to authorized U.S. customs agents and importers to facilitate entry of products into the U.S. I declare that I have read, understood and accepted terms and conditions.

Name^*

Title (e.g. CEO, President, etc.)^*

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