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  2. Registration and US Agent Form

Registration and US Agent Form

Step 1 of 4

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  • Submitter Information

  • Facility Address Information

  • Mailing Address Information

  • Parent Company Name/Address Information

  • Emergency Contact Information

  • Trade Names

    If this facility uses trade names other than previously mentioned, list them here (e.g., "Also doing business as," "Facility also known as")
  • Product information

  • 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.


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