FDA Food Facility Registration Form

US FDA Food Facility Registration (Bioterrorism Act) is required for both domestic and foreign facilities
that manufacture, process, pack, or hold food for consumption in the United States.
Foreign facilities must designate a United States agent (U.S. agent) for purposes of registration. The agent
is required to reside or maintain a place of business in the United States and to be physically present in the
United States. The U.S. agent acts as a communications link between FDA and the foreign facility for both
emergency and routine communications. The U.S. agent will be the person FDA contacts when an
emergency occurs, unless the registration specifies under 1.233(e) another emergency contact.
First Choice Consulting Services Regulatory expert team can help you with proper registration of your
Food, Beverage and Dietary supplement facilities with US FDA and by acting as your Unites States Agent.
We submit all of the required United States Food and Drug Administration (FDA) Food Facility
Registration information on behalf of you and provide you FDA assigned 11 digit FDA Registration
number.

For Fee and Payment information, please visit www.fdaregistration-consulting.com

Email signed completed US FDA Food Facility Registration form at firstchoice_consulting@yahoo.com

We are always happy to help you. If you have any questions or need any U.S. FDA Food, Beverage and
Dietary supplement regulatory assistance, please feel free to contact us.

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Print Form

FDA Food Facility Registration Form

TYPE OF REGISTRATION
New FDA Food Facility Registration.
A new Owner of a previously registered Food Facility with FDA.
Name of the previous Owner of the facility: _____ ______________________________________
Title

Complete Name

Previous Owner's 11 digit FDA Registration number: ____________________________________

COMPANY INFORMATION
Facility Name: _______________________________________________________________________
(Please include Business Entity eg. corporation, limited, company, etc, if any)

Business Type:

Manufacturer

Processer

Warehouse

Others: ______________________________________________

Do you take physical possession of the goods?

Packer

Yes

Distributor

Importer

Broker

No

Street Address: ______________________________________________________________________

City: _____________________ State/Province: ______________________ ZIP/Postal code: ________
Country: ______________________________ Email: _______________________________________
Telephone: ____________________________ Telephone Extensions (if any): ___________________
Fax: __________________________________ Website: _____________________________________
PREFERRED MAILING ADDRESS
Street Address: ______________________________________________________________________
City: _____________________ State/Province: ______________________ ZIP/Postal code: ________
Country: ______________________________ Email: _______________________________________
Telephone: ____________________________ Fax: _________________________________________
PARENT COMPANY INFORMATION (if applicable)
Parent Company Name: _______________________________________________________________
(Please include Business Entity eg. corporation, limited, company, etc, if any)

Street Address: ______________________________________________________________________

City: _____________________ State/Province: ______________________ ZIP/Postal code: ________
Country: ______________________________ Email: _______________________________________
Telephone: ____________________________ Phone Ext.: __________ Fax: ____________________
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ALTERNATE TRADE NAMES

Other Business Trading Names (Facility Also Known As or Doing Business As) if any,
1. _____________________________________________________________________________
2. _____________________________________________________________________________
3. _____________________________________________________________________________
4. _____________________________________________________________________________
FACILITY OWNER / OPERATOR INFORMATION
Name of Owner / Operator: _____________________________________________________________
Street Address: ______________________________________________________________________
City: _____________________ State/Province: ______________________ ZIP/Postal code: ________
Country: ______________________________ Email: _______________________________________
Telephone: ____________________________ Fax: _________________________________________
FACILITY EMERGENCY CONTACT INFORMATION
Contact Name: _____ / _____________________/_____________________/_____________________
Title

First Name

Middle Name

Last Name

Job Title: ______________________________ Email: ______________________________________

Emergency Contact Phone: ____________________________________ Phone Ext.: ______________
SEASONAL FACILITY DATES OF OPERATION (Optional)
Whether your Facility operates on a seasonal basis?
No
Yes (If yes, Harvest Period I: __________/__________ Harvest Period II: _________/________)
Start Month

End Month

Start Month End Month

TYPES OF STORAGE (for warehouse/holding facility)

Ambient Storage (neither frozen nor refrigerated)

Refrigerated Storage

Frozen Storage

GENERAL PRODUCT CATEGORIES

Food for Human Consumption

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Food for Animal Consumption

Both

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PRODUCT INFORMATION

List all major Products that your company handles.

Please refer below for Product Category and Type of activity conducted at the facility.
Product Name

Product Category

Type of activity
conducted at the facility

1.
2.
3.
4.
5.
6.
7.
8.

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.
PAYMENT INFORMATION
PayPal Transaction Number (ID): ________________________________________________________
Date of Payment: _ _ - _ _ - 201__

Comments (If any):

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Product Categories:
1. Acidified Foods

14. Dressing And Condiments

2. Alcoholic Beverages

15. Fisher / Seafood Product Categories

A. Fin Fish, Whole Or Filet
B. Shellfish
C. Ready To Eat (Rte) Fishery Products
D. Processed And Other Fishery Products
3. Baby (Infant And Junior) Food Products 16. Food Additives, Generally Recognized
Including Infant Formula
As Safe (GRAS) Ingredients, Or Other
Ingredients used for processing
4. Bakery Products, Dough Mixes, or
17. Food Sweeteners (Nutritive)
Icings

5. Beverage Bases

27. Multiple Food Dinners, Gravies,

Sauces And Specialties
28. Nuts And Edible Seed Product
Categories
A. Nut And Nut Products
B. Edible Seed And Edible Seed
Products
29. Prepared Salad Products

30. Shell Egg And Egg Product

Categories
A. Chicken Egg And Egg Products
B. Other Eggs And Egg Products
31. Snack Food Items (Flour, Meal or
Vegetable Base)

18. Fruit And Fruit Products

A. Fresh Cut Produce
B. Raw Agricultural Commodities
C. Other Fruit And Fruit Products
6. Candy Without Chocolate, Candy
19. Fruit Or Vegetable Juice, Pulp Or
32. Spices, Flavors, And Salts
Specialties and Chewing Gum
Concentrate Products
7. Cereal Preparations, Breakfast Foods, 20. Gelatin, Rennet, Pudding Mixes, Or Pie 33. Soups
Quick Cooking / Instant Cereals
Fillings
8. Cheese And Cheese Product Categories 21. Ice Cream And Related Products
34. Soft Drinks And Waters
A. Soft, Ripened Cheese
B. Semi-Soft Cheese
C. Hard Cheese
D. Other Cheeses And Cheese Products
9. Chocolate And Cocoa Products
22. Imitation Milk Products
35. Vegetable Product Categories
A. Fresh Cut Products
B. Raw Agricultural Commodities
C. Other Vegetable And Vegetable Products
10. Coffee And Tea
23. Low Acid Canned Food (LACF) Product 36. Vegetable Oils (Includes Olive Oil)
11. Color Additives For Foods
24. Macaroni Or Noodle Products
37. Vegetable Protein Products
(Simulated Meats)
12. Dietary Conventional Foods or Meal 25. Meat, Meat Products And Poultry (FDA 38. Whole Grains, Miller Grain
Replacements (Includes Medical Foods) Regulated)
Products (Flours), or Starch
13. Dietary Supplement Categories
26. Milk, Butter, Or Dried Milk Products
A. Proteins, Amino Acids, Fats And Lipid
Substances
B. Vitamins And Minerals
C. Animal By-Products And Extracts
D. Herbals And Botanicals
If none of the above food categories apply, then print the applicable food category or categories (that does not or do not appear above)

Type of activity conducted at the facility:

1. Warehouse / Holding Facility (e.g. storage facilities, including storage tanks, grain elevators)
2. Acidified / Low Acid Food Processor
5.Commissary
8. Manufacturer / Processor
3. Interstate Conveyance Caterer / Catering Point 6. Contract Sterilizer
9. Repacker / Packer
4. Molluscan Shellfish Establishment
7. Labeler / Relabeler
10.Salvage Operator (Reconditioner)

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AGREEMENT
First Choice Consulting Services and the undersigned party have today entered into an agreement
regarding the provision of consulting services on the terms and conditions laid out in this Agreement.

The services provided by First Choice Consulting Services will be performed in a professional
manner in accordance with generally accepted industry standards.

The Client agrees to provide accurate and sufficient information, adequate technical assistance
and documentation, required for First Choice Consulting Services to be able to perform the
Services. The Client shall promptly provide further information that First Choice Consulting
Services reasonably deems relevant to perform the task.

The Client is solely responsible for the scientific accuracy, material facts and completeness of
information provided to First Choice Consulting Services.

Customer authorizes First Choice Consulting Services to submit the furnished FDA Registration
information to the U.S. Food and Drug Administration (FDA) or other agency required by law.

For the Services provided by First Choice Consulting Services, Customer agrees to pay First
Choice Consulting Services the fees set forth in a quote issued by First Choice Consulting
Services to Customer or as otherwise agreed to by First Choice Consulting Services and
Customer plus any applicable taxes or other charges.

The Parties agree to make all reasonable efforts, in good faith, to resolve any dispute arising
from implementation of this agreement through informal discussions and the development of
mutual satisfactory options.

First Choice Consulting Services liability in whatever kind or nature cannot exceed the fee for
performing the task.

This Agreement shall terminate automatically upon completion by First Choice Consulting
Services of the Services required by this Agreement or on December 31, 2015.

First Choice Consulting Services is a Private business entity and is not affiliated with U.S. FDA.

By singing below, Customer agrees to be bound by this Agreement:

Company Name: _________________________ Signature: _____________________________________
Date: _ _ - _ _ - 201__

Authorized Person Name: _________________________

(Managing Director, Proprietor, General Manager, etc.)

Place: __________________________________ Job Title: ______________________________________

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