Step 1 of 5 0% Submitter InformationYour Name* Prefix Mr.Mrs.Ms.Dr. First Last Phone Number (Include Area/Country Code)*Email* Facility Address InformationFacility Name*Facility Name SuffixCompanyCorporationLimitedLimited Liability CorporationIncorporatedNon-Profit OrganizationCooperativeLimited PartnershipOtherOtherFacility Address* Street Address City State / Province / Region ZIP / Postal Code Country AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Email Address* Phone Number (Include Area/Country Code)*Fax (Include Area/Country Code)Is the preferred mailing address the same as the facility address?YesNoMailing Address InformationMailing Address* Street Address City State / Province / Region ZIP / Postal Code Country AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Email Address* Phone Number (Include Area/Country Code)*Fax (Include Area/Country Code)Is the parent company address the same as the facility address or preferred mailing address?Same as Facility AddressSame as Preferred Mailing AddressNone of the aboveParent Company Name/Address InformationParent name*Parent Company Address Information* Street Address City State / Province / Region ZIP / Postal Code Country AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Email Address* Phone Number (Include Area/Country Code)*Fax (Include Area/Country Code)Emergency Contact InformationIf information is the same as another section, check which section:Same as Facility AddressSame as Submitter InformationOtherContact Name* Prefix Mr.Mrs.Dr. First Last Contact Phone (Include Area/Country Code)*Contact Email Address* Trade NamesIf this facility uses trade names other than previously mentioned, list them here (e.g., "Also doing business as," "Facility also known as")Are there alternate trade names used by your facility in addition to the name provided in previous sections?NoYesAlternate Trade Name #1*Alternate Trade Name #2* 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 7a. CHEESE AND CHEESE PRODUCT CATEGORIES, Soft, Ripened Cheese 7b. CHEESE AND CHEESE PRODUCT CATEGORIES, Semi-Soft Cheese 7c. CHEESE AND CHEESE PRODUCT CATEGORIES, Hard Cheese 7d. CHEESE AND CHEESE PRODUCT CATEGORIES, 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) 12a. DIETARY SUPPLEMENT CATEGORIES, Proteins, Amino Acids, Fats and Lipid Substances 12b. DIETARY SUPPLEMENT CATEGORIES, Vitamins and Minerals 12c. DIETARY SUPPLEMENT CATEGORIES, Animal By-Products and Extracts 12d. DIETARY SUPPLEMENT CATEGORIES, Herbals and Botanicals 13. DRESSING AND CONDIMENTS 14a. FISHERY / SEAFOOD PRODUCT CATEGORIES, Fin Fish, Whole or Filet 14b. FISHERY / SEAFOOD PRODUCT CATEGORIES, Molluscan Shellfish 14c. FISHERY / SEAFOOD PRODUCT CATEGORIES, Other Shellfish 14d. FISHERY / SEAFOOD PRODUCT CATEGORIES, Ready to Eat (RTE) Fishery Products 14e. FISHERY / SEAFOOD PRODUCT CATEGORIES, Processed and Other Fishery Products 15. FOOD ADDITIVES, GENERALLY RECOGNIZED AS SAFE (GRAS) INGREDIENTS, OR OTHER INGREDIENTS USED FOR PROCESSING 16. FOOD SWEETENERS (NUTRITIVE) 17a. FRUIT AND FRUIT PRODUCTS, Fresh Cut Produce 17b. FRUIT AND FRUIT PRODUCTS, Raw Agricultural Commodities 17c. FRUIT AND FRUIT PRODUCTS, 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 26a. NUTS AND EDIBLE SEED PRODUCT CATEGORIES, Nut and Nut Products 26b. NUTS AND EDIBLE SEED PRODUCT CATEGORIES, Edible Seed and Edible Seed Products 27. PREPARED SALAD PRODUCTS 28a. SHELL EGG AND EGG PRODUCT CATEGORIES, Chicken Egg and Egg Products 28b. SHELL EGG AND EGG PRODUCT CATEGORIES, 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 33a. VEGETABLE AND VEGETABLE PRODUCT CATEGORIES, Fresh Cut Products 33b. VEGETABLE AND VEGETABLE PRODUCT CATEGORIES, Raw Agricultural Commodities 33c. VEGETABLE AND VEGETABLE PRODUCT CATEGORIES, 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). Select all the activities conducted at the 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 ConditionTerms and Conditions