Step 1 of 5 0% Please do not use this form when your facility is located outside the USA. You can use this form instead: Registration and US Agent Submitter InformationYour Name* Prefix Mr.Mrs.Ms.Dr. First Last Phone Number (Include Area Code)*Email* Facility InformationFacility Name*Facility Name SuffixCompanyCorporationLimitedLimited Liability CorporationIncorporatedNon-Profit OrganizationCooperativeLimited PartnershipOtherOtherAddress* Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Please do not use this form when your facility is located outside the USA. You can use this form instead: Registration and US Agent Email Address* Phone Number (Include Area Code)*Fax (Include Area Code)Emergency Contact InformationContact Name* Mr.Mrs.Ms.Dr. Prefix First Last Contact Phone (Include Area Code)*Contact Email* Product informationGeneral Product Categories - Human/Animal/Both* Food for Human Consumption Food for Animal Consumption Select all the food categories for human consumption that are handled at facility: 1 ALCOHOLIC BEVERAGES 2 BABY (INFANT AND JUNIOR) FOOD PRODUCTS Including Infant Formula 3 BAKERY PRODUCTS, DOUGH MIXES, OR ICINGS 4 BEVERAGE BASES 5 CANDY WITHOUT CHOCOLATE, CANDY SPECIALTIES AND CHEWING GUM 6 CEREAL PREPARATIONS, BREAKFAST FOODS, QUICK COOKING / INSTANT CEREALS 7 CHEESE AND CHEESE PRODUCT CATEGORIES 7a Soft, Ripened Cheese 7b Semi-Soft Cheese 7c Hard Cheese 7d Other Cheeses and Cheese Products 8 CHOCOLATE AND COCOA PRODUCTS 9 COFFEE AND TEA 10 COLOR ADDITIVES FOR FOODS 11 DIETARY CONVENTIONAL FOODS OR MEAL REPLACEMENTS (Includes Medical Foods) 12 DIETARY SUPPLEMENT CATEGORIES 12a Proteins, Amino Acids, Fats and Lipid Substances 12b Vitamins and Minerals 12c Animal By-Products and Extracts 12d Herbals and Botanicals 13 DRESSING AND CONDIMENTS 14 FISHERY / SEAFOOD PRODUCT CATEGORIES 14a Fin Fish, Whole or Filet 14b Molluscan Shellfish 14c Other Shellfish 14d Ready to Eat (RTE) Fishery Products 14e Processed and Other Fishery Products 15 FOOD ADDITIVES, GENERALLY RECOGNIZED AS SAFE (GRAS) INGREDIENTS, OR OTHER INGREDIENTS USED FOR PROCESSING 16 FOOD SWEETENERS (NUTRITIVE) 17 FRUIT AND FRUIT PRODUCTS 17a Fresh Cut Produce 17b Raw Agricultural Commodities 17c Other Fruit and Fruit Products 18 FRUIT OR VEGETABLE JUICE, PULP OR CONCENTRATE PRODUCTS 19 GELATIN, RENNET, PUDDING MIXES, OR PIE FILLINGS 20 ICE CREAM AND RELATED PRODUCTS 21 IMITATION MILK PRODUCTS 22 MACARONI OR NOODLE PRODUCTS 23 MEAT, MEAT PRODUCTS AND POULTRY (FDA REGULATED) 24 MILK, BUTTER, OR DRIED MILK PRODUCTS 25 MULTIPLE FOOD DINNERS, GRAVIES, SAUCES AND SPECIALTIES 26 NUTS AND EDIBLE SEED PRODUCT CATEGORIES 26a Nut and Nut Products 26b Edible Seed and Edible Seed Products 27 PREPARED SALAD PRODUCTS 28 SHELL EGG AND EGG PRODUCT CATEGORIES 28a Chicken Egg and Egg Products 28b Other Eggs and Egg Products 29 SNACK FOOD ITEMS (FLOUR, MEAL OR VEGETABLE BASE) 30 SPICES, FLAVORS, AND SALTS 31 SOUPS 32 SOFT DRINKS AND WATERS 33 VEGETABLE AND VEGETABLE PRODUCT CATEGORIES 33a Fresh Cut Products 33b Raw Agricultural Commodities 33c Other Vegetable and Vegetable Products 34 VEGETABLE OILS (INCLUDES OLIVE OIL) 35 VEGETABLE PROTEIN PRODUCTS (SIMULATED MEATS) 36 WHOLE GRAINS, MILLER GRAIN PRODUCTS (FLOURS), OR STARCH 37 OTHER IF NONE OF THE ABOVE FOOD CATEGORIES APPLY, THEN PRINT THE APPLICABLE FOOD CATEGORY OR CATEGORIES (THAT DOES NOT OR DO NOT APPEAR ABOVE)Select all the food categories for animal consumption that are handled at facility: 1. GRAIN OR GRAIN PRODUCTS (I.E., BARLEY, GRAIN SORGHUMS, MAIZE, OAT, RICE, RYE, WHEAT, OTHER GRAINS OR GRAIN PRODUCTS) 2. OILSEED OR OILSEED PRODUCTS (I.E., COTTONSEED, SOYBEANS, OTHER OILSEEDS OR OILSEED PRODUCTS) 3. ALFALFA PRODUCTS OR LESPEDEZA PRODUCTS 4. AMINO ACIDS OR RELATED PRODUCTS 5. ANIMAL PROTEIN PRODUCTS 6. BOTANICALS AND HERBS 7. BREWER PRODUCTS 8. CHEMICAL PRESERVATIVES 9. CITRUS PRODUCTS 10. DIRECT FED MICROBIALS 11. DISTILLERY PRODUCTS 12. ENZYMES 13. FATS OR OILS 14. FERMENTATION PRODUCTS 15. FORAGE PRODUCTS 16. HUMAN FOOD BY-PRODUCTS NOT OTHERWISE LISTED 17. MARINE PRODUCTS 18. MILK PRODUCTS 19. MINERALS OR MINERAL PRODUCTS 20. MISCELLANEOUS OR SPECIAL PURPOSE PRODUCTS 21. MOLASSES OR MOLASSESS PRODUCTS 22. NON-PROTEIN NITROGEN PRODUCTS 23. PEANUT PRODUCTS 24. PROCESSED ANIMAL WASTE PRODUCTS 25. SCREENINGS 26. TECHNICAL ADDITIVES 27. VITAMINS OR VITAMIN PRODUCTS 28. YEAST PRODUCTS 29. MIXED FEED (E.G., POULTRY, LIVESTOCK, EQUINE) 30. PET FOOD 31. PET TREATS OR PET CHEWS 32. PET NUTRITIONAL SUPPLEMENTS (E.G., VITAMINS, MINERALS) 33. OTHER IF NONE OF THE ABOVE FOOD CATEGORIES APPLY, THEN PRINT THE APPLICABLE FOOD CATEGORY OR CATEGORIES (THAT DOES NOT OR DO NOT APPEAR ABOVE). Types of Activity Conducted at the Facility*Please check for all types of operations that are performed at this facility. Manufacturer / Processor Ambient Food Storage Warehouse / Holding Facility Labeler / Relabeler Refrigerated Food Storage Warehouse / Holding Facility Packer / Repacker Frozen Food Storage Warehouse / Holding Facility Low-Acid Food Processor Acidified Food Processor Farm Mixed-Type Facility Other If the type of activity you perform is not listed, please indicate the type of activity you perform on each food category here: Certification Statement*By submitting this form to register-FDA, or by authorizing an individual to submit this form to register-FDA, the owner or operator in charge of the facility certifies that the above information is true and accurate. The owner or operator in charge of the facility also authorizes register-FDA to submit the registration on the facility's behalf and FDA will be permitted to inspect the facility at the time and in the manner permitted by the Federal Food, Drug, and Cosmetic Act. Our Terms & Conditions apply. I agree.*Terms and Conditions*I have read and agree to the Terms and Conditions.Terms and Conditions