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TRANSCRIPT
Steve Troxler
Commissioner North Carolina Department of Agriculture and Consumer Services
Food and Drug Protection Division
NEW ANIMAL FEED PRODUCT REGISTRATION FORM
Anita MacMullan
Director
Application is hereby made for registration of the Commercial Feeding Stuffs and/or Canned Pet Foods listed below for a
period beginning with the actual date of registration and continuing until the last day of the calendar year.
Firm Name and Physical Address appearing on label: Agent or Mailing Address:
Firm Name Agent Name
Mailing Address
City & State
Country
Contact Name
Agent Phone #
Agent Email
Firm Address
City & State Zip Zip
Country
Contact Name
Phone #
Enter Quantity FEE SCALE is determined by package size(s) offered for sale.
$5.00 per Brand sold in packages over 5 lbs.
$40.00 per Brand sold in packages of 5 lbs. or less.
$45.00 per Brand sold in packages of 5 lbs. or less & over 5 lbs.
$12.00 per Brand sold in Canned or Hermetically Sealed Containers.
$30.00 per product if applicable for late registration. DELINQUENCY FEES
Total Fees
A label must be submitted for each product listed on this form. Use additional forms to add more than 10 products.
Select Fee Brand Name format: Company Name Brand Name Species or as written in the AAFCO statement
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10.
Applicants please do not write in this portion.
Check
Number
Check
Total
Fees
Total
Date
Reg
Check
Name Firm ID
Control
Number
2nd Control Number/Split Check
NCDA&CS, Animal Feed Program 1070 Mail Service Center Raleigh, NC 27699-1070 Main (919) 733-7366 Fax (919) 733-6801