Information and documentation required for a as required by

							                                                                                                  PRODUCT CLASSIFICATION (IN-STATE ONLY)
   Information and documentation required for a
              PRODUCT CLASSIFICATION                                                   Payment in advance is required – check or money order made payable to the
     as required by FDA and Georgia Department of Agriculture,                         University of Georgia, or provide credit card authorization information below.
   for food products that will be produced by a licensed co-packer.                    Product will not be shipped without full payment.
  All recipe/formula ingredient information is kept strictly confidential.
  Once approved, a letter of product classification will be issued to the     INSIDE
  Georgia Department of Agriculture’s Consumer Protection Division, who      GEORGIA
                                                                                                      Service/Item                       Cost             Total
                                                                               ONLY
  will then contact you.
          Please allow at least three weeks for processing.                             Product classification fee (covers all      $75.00
                                                                                        products submitted at one time)
Please type or write legibly (on separate sheet) the information below about the        Product testing (pH, Brix, etc.)            add $25.00 for
process used to make each product:                                                                                                  each product

    1) Recipe/formula with all ingredients with accurate measurement/weight             SUBTOTAL OF ORDER
       (i.e., grams, pounds, ounces, etc. - household measure is acceptable).
    2) Product lot/batch code procedure (consult your co-packer)                        ** Georgia Sales Tax (your county’s is ____%)
    3) Recall procedures
                                                                                        TOTAL OF ORDER                                           $
Name of product(s): _________________________________________________                   Payment Method

 Co-Packer Company:                                                                     ___ Check No. _____ or money order for $__________
                                                                                        payable to the University of Georgia
 Contact Person:
                                                                                        __ Visa             __ MasterCard        __ Discover         __ AmEx
 Mailing Address:
 City/State/Zip:                                                                        Card number:
 Phone/Fax:                                                                             Expiration date (MM/YY):
 Email:
                                                                                        Signature:
Send required information with sample of product(s) and payment to the address          Print name of signer:
below. Please be sure your name and the product name appear on all pages!
                                                                                        Contact Name:

Mail to:     Process Approval                                                           Company Name:
             University of Georgia
             Extension Food Science                                                     Mailing Address:
             240A Food Science Building                                                 Street Address:
             Athens, GA 30602-2610
                                                                                        City/State/Zip:
             Phone: 706/542-2574
             Website: www.EFSonline.uga.edu                                             Phone/Cell:

                                                                                        Fax:
**Check or money order requests that do not include sales tax will be held
until the balance of the payment is received. Sales tax will be figured into
                                                                                        Email:
credit card payments and a receipt will be issued.