Food Facility Registration

Registration form

Your Name*

Your E-mail*

Repeat Your E-mail*

2 + 2 =*

Step 1: Registration Information

Section 1: Registration Information.

Is this facility engaged in the manufacturing/processing, packing, or holding of food for human or animal consumption in the United States?*

Yes
No

Are you a broker, distributor, importer/filer?*

Yes
No

Section 1a: Type of Registration.

Registration Information Facility Location. Please Select*

Are you the new owner of a previously registered facility?*

Yes
No

If "Yes", provide the following information, if known.

Previous Owner's Title (Optional)

Please Select

Previous Owner's Name (Optional)

Previous Owner's Registration Number (Optional)

Step 2: Contact Information

Section 2: Facility Information.

Facility Name/Address Information

Facility name*

Facility address*

Facility Type

Company*

Country/Area*

Street Address*

Street Address - Line 1*

Street Address - Line 2 (Optional)*

Zip/Postal Code*

Please, enter 'NONE' in Zip code field if Zip codes are not used in selected Country/Area.

Phone Number*

Fax Number

City (Non-US)*

Please Select*

Telephone Number*

Extension

Fax Number (Optional)

E-Mail Address*

Repeat E-Mail Address*

Section 3: Preferred Mailing Address Information.

Please enter preferred mailing address information*

Is the preferred mailing address the same as the facility address (Section 2)?*

Yes
No

Section 4: Parent Company Name/Address Information.

Please enter parent company name*

Address information*

Is the parent company address the same as the facility address or preferred mailing address (Sections 2 and 3)?*

Step 3: Additional Information

Section 5: Facility Emergency Contact Information.

For foreign facilities, FDA will use your U.S. agent as your emergency contact unless you choose to designate a different contact here

If information is the same as another section, check which section

Section 6: Trade Names.

Alternate Trade Names

Are there alternate trade names used by your facility in addition to the name provided in Section 2: Facility Name/Address Information?

Yes
No

Section 7: United States Agent

Are you an individual, partnership, corporation, or association?

Title

First Name

Middle Name (Optional)

Last Name

Country/Area

Street Address

Line 1 Street Address

Line 2 (Optional)

Zip Code

Please enter 'NONE' in Zip code field if Zip codes are not used in selected Country/Area.

City

Please Select

Telephone Number

Emergency Contact Telephone Number:

Complete name

Telephone Number

Fax Number (Optional)

E-Mail Address

Aditional E-Mail Address

Step 4: Optional Information

Section 8: Seasonal Facility Dates of Operation Optional Information.

Give the approximate dates that your facility is open for business, if its operations are on a seasonal basis (Optional):

Dates of Operation

Section 9: General Product Categories - Human/Animal/Both

Category

Step 5: Product Categories

Section 9: General Product Categories - Food for Human Consumption; and Type of Activity Conducted at the Facility.

Important: To be completed by all food facilities. Please see instructions for further examples. IF NONE OF THE MANDATORY CATEGORIES BELOW APPLY, SELECT BOX 37.

1. ALCOHOLIC BEVERAGES [21 CFR 170.3 (n) (2)]
2. BABY (INFANT AND JUNIOR) FOOD PRODUCTS Including Infant Formula
3. BAKERY PRODUCTS, DOUGH MIXES, OR ICINGS [21 CFR 170.3 (n) (1), (9)]
4. BEVERAGE BASES [21 CFR 170.3 (n) (3), (35)]
5. CANDY WITHOUT CHOCOLATE, CANDY SPECIALTIES AND CHEWING GUM [21 CFR 170.3 (n) (6), (9), (25), (38)]
6. CEREAL PREPARATIONS, BREAKFAST FOODS, QUICK COOKING / INSTANT CEREALS [21 CFR 170.3 (n) (4)]
7. CHEESE AND CHEESE PRODUCT CATEGORIES [21 CFR 170.3 (n) (5)] (a. Soft, Ripened Cheese / b. Semi-Soft Cheese / c. Hard Cheese / d. Other Cheeses and Cheese Products)
8. CHOCOLATE AND COCOA PRODUCTS [21 CFR 170.3 (n) (3), (9), (38), (43)]
9. COFFEE AND TEA [21 CFR 170.3 (n) (3), (7)]
10. COLOR ADDITIVES FOR FOODS [21 CFR 170.3 (o) (4)]
11. DIETARY CONVENTIONAL FOODS OR MEAL REPLACEMENTS (Includes Medical Foods) [21 CFR 170.3 (n) (31)]
12. DIETARY SUPPLEMENT CATEGORIES (a. Proteins, Amino Acids, Fats and Lipid Substances [21 CFR 170.3(o) (20)] / b. Vitamins and Minerals / c. Animal By-Products and Extracts / d. Herbals and Botanicals)
13. DRESSING AND CONDIMENTS [21 CFR 170.3 (n) (8), (12)]
14. FISHERY / SEAFOOD PRODUCT CATEGORIES [21 CFR 170.3 (n) (13), (15), (39), (40)] (a. Fin Fish, Whole or Filet / b. Molluscan Shellfish / c. Other Shellfish / d. Ready to Eat (RTE) Fishery Products / e. Processed and Other Fishery Products)
15. FOOD ADDITIVES, GENERALLY RECOGNIZED AS SAFE (GRAS) INGREDIENTS, OR OTHER INGREDIENTS USED FOR PROCESSING [21 CFR 170.3 (n) (42); 21 CFR 170.3 (o) (1), (2), (3), (5), (6), (7), (8), (9), (10), (11), (12), (13), (14), (15), (16), (17), (18), (19), (22), (2
16. FOOD SWEETENERS (NUTRITIVE) [21 CFR 170.3 (n) (9) (41), 21 CFR 170.3 (o) (21)]
17. FRUIT AND FRUIT PRODUCTS [21 CFR 170.3 (n) (16), (27), (28), (35), (43)] (a. Fresh Cut Produce / b. Raw Agricultural Commodities / c. Other Fruit and Fruit Products)
18. FRUIT OR VEGETABLE JUICE, PULP OR CONCENTRATE PRODUCTS [21 CFR 170.3 (n) (3), (16), (35)]
19. GELATIN, RENNET, PUDDING MIXES, OR PIE FILLINGS [21 CFR 170.3 (n) (22)]
20. ICE CREAM AND RELATED PRODUCTS [21 CFR 170.3 (n) (20), (21)]
21. IMITATION MILK PRODUCTS [21 CFR 170.3 (n) (10)]
22. MACARONI OR NOODLE PRODUCTS [21 CFR 170.3 (n) (23)]
23. MEAT, MEAT PRODUCTS AND POULTRY (FDA REGULATED) [21 CFR 170.3 (n) (17), (18), (29), (34), (39), (40)]
24. MILK, BUTTER, OR DRIED MILK PRODUCTS [21 CFR 170.3 (n) (12), (30), (31)]
25. MULTIPLE FOOD DINNERS, GRAVIES, SAUCES AND SPECIALTIES [21 CFR 170.3 (n) (11) (14), (17), (18), (23), (24), (29), (34), (40)]
26. NUTS AND EDIBLE SEED PRODUCT CATEGORIES [21 CFR 170.3 (n) (26), (32)] (a. Nut and Nut Products / b. Edible Seed and Edible Seed Products)
27. PREPARED SALAD PRODUCTS [21 CFR 170.3 (n) (11), (17), (18), (22), (29), (34), (35)]
28. SHELL EGG AND EGG PRODUCT CATEGORIES [21 CFR 170.3 (n) (11), (14)] (a. Chicken Egg and Egg Products / b. Other Eggs and Egg Products)
29. SNACK FOOD ITEMS (FLOUR, MEAL OR VEGETABLE BASE) [21 CFR 170.3 (n) (37)]
30. SPICES, FLAVORS, AND SALTS [21 CFR 170.3 (n) (26)]
31. SOUPS [21 CFR 170.3 (n) (39), (40)]
32. SOFT DRINKS AND WATERS [21 CFR 170.3 (n) (3), (35)]
33. VEGETABLE AND VEGETABLE PRODUCT CATEGORIES [21 CFR 170.3 (n) (19), (36)] (a. Fresh Cut Products / b. Raw Agricultural Commodities / c. Other Vegetable and Vegetable Products)
34. VEGETABLE OILS (INCLUDES OLIVE OIL) [21 CFR 170.3 (n) (12)]
35. VEGETABLE PROTEIN PRODUCTS (SIMULATED MEATS) [21 CFR 170.3 (n) (33)]
36. WHOLE GRAINS, MILLER GRAIN PRODUCTS (FLOURS), OR STARCH [21 CFR 170.3 (n) (1), (23)]
37. IF NONE OF THE ABOVE FOOD CATEGORIES APPLY, THEN PRINT THE APPLICABLE FOOD CATEGORY OR CATEGORIES (THAT DOES NOT OR DO NOT APPEAR ABOVE)

Step 6: Owner, Operator, or Agent-in-Charge Information

Section 10: Owner, Operator, or Agent-in-Charge Information.

Name of Entity or Individual Who is the Owner, Operator, or Agent-in-Charge.

Is their contact information the same as any of the previous sections?*

Section 11: Inspection Statement.

FDA will be permitted to inspect the facility at the time and in the manner permitted by the Federal Food, Drug, and Cosmetic Act.

Section 12: Certification Statement.

The owner, operator, or agent-in-charge of the facility, or an individual authorized by the owner, operator, or agent-in-charge of the facility, must submit this form.

Name of the Submitter*

INDIVIDUAL ASSOCIATED WITH THE INFORMATION IN SECTION 10 (STOP HERE, FORM IS COMPLETED)
ANOTHER AUTHORIZED INDIVIDUAL

Check word:

Contact information.

United States of America

+(1) 855-300-7171

Russia

+(7) 912-825-38-00

E-mail

info@firstmetropoliscorp.com