Grain Free Certification Application • Paleo Foundation

Grain-Free Certified ™ Application

Is Grain-Free the New Gluten-Free? Industry reports and trends analysis say ‘Yes!’ Grain-free Certified products are a step beyond a conventional gluten-free products by eliminating all grains and pseudograins from the diet. Congratulations on taking your first active step towards the most powerful way to increase brand trust and sales with grain-free customers by completing your Grain Free Certified Application!

Grain Free Certified Application
Company Name

(Company Name) seeks permission to use the “Grain Free Certification” Trademark, hereinafter referred to as the logo, on the attached list of product(s).
Name
Title
Signature
Date
MM slash DD slash YYYY
*
Street Address City State / Province / Region ZIP / Postal Code Country
Phone
Fax
Website URL
Email
Twitter @
Instagram @
Facebook /
How did you hear about us?
Referred by: (Name and Contact info)
Information submitted in this Grain Free Certification application will be kept in strict confidentiality.
Products being submitted for Grain Free Certification
Product Name
Please use one row per supplier. Use + sign to add more rows.*
Please use one row per supplier. Use + sign to add more rows.
Ingredients Supplier Supplier email / phone
Extra Notes:
Do you want to submit another product for Grain Free Certification?*
- Yes
- No
Title
*
Ingredients Supplier Supplier email / phone
Extra Notes:
Do you want to submit another product for Grain Free Certification?
- Yes
- No
Title
*
Ingredients Supplier Supplier email / phone
Extra Notes:
Do you want to submit another product for Grain Free Certification?
- Yes
- No
Title
*
Ingredients Supplier Supplier email / phone
Extra Notes:
Do you want to submit another product?
- Yes
- No
Title
*
Ingredients Supplier Supplier email / phone
Extra Notes:
Do you want to submit another product for Grain Free Certification?
- Yes
- No
Title
*
Ingredients Supplier Supplier email / phone
Extra Notes:
Do you want to submit another product for Grain Free Certification?
- Yes
- No
Title
*
Ingredients Supplier Supplier email / phone
Extra Notes:
Do you want to submit another product for Grain Free Gluten Free Certification?
- Yes
- No
Title
*
Ingredients Supplier Supplier email / phone
Extra Notes:
Do you want to submit another product for Grain Free Gluten Free Certification?
- Yes
- No
Title
*
Ingredients Supplier Supplier email / phone
Extra Notes:
Do you want to submit another product for Grain Free Certification?
- Yes
- No
Title
*
Ingredients Supplier Supplier email / phone
Extra Notes:
Do you want to submit another product for Grain Free Certification?
- Yes
- No
Title
*
Ingredients Supplier Supplier email / phone
Extra Notes:
Do you want to submit another product for Grain Free Certification?
- Yes
- No
Title
*
Ingredients Supplier Supplier email / phone
Extra Notes:
Do you want to submit another product for Grain Free Certification?
- Yes
- No
Title
*
Ingredients Supplier Supplier email / phone
Extra Notes:
Do you want to submit another product for Grain Free Certification?
- Yes
- No
Title
*
Ingredients Supplier Supplier email / phone
Extra Notes:
Do you want to submit another product for Grain Free Certification?
- Yes
- No
Title
*
Ingredients Supplier Supplier email / phone
Extra Notes:
Do you want to submit another product for Grain Free Certification?
- Yes
- No
Title
*
Ingredients Supplier Supplier email / phone
Extra Notes:
Do you want to submit another product for Grain Free Certification?
- Yes
- No
Title
*
Ingredients Supplier Supplier email / phone
Extra Notes:
Do you want to submit another product for Grain Free Certification?
- Yes
- No
Title
*
Ingredients Supplier Supplier email / phone
Extra Notes:
Do you want to submit another product for Grain Free Certification?
- Yes
- No
Title
*
Ingredients Supplier Supplier email / phone
Extra Notes:
Do you want to submit another product for Grain Free Certification?
- Yes
- No
Title
*
Ingredients Supplier Supplier email / phone
Extra Notes:
Processing Methods Information regarding processing methods and location must be detailed. List any cleaning methods for shared machinery with grains, and pseudograins. Note: Use of shared machinery does not automatically disqualify products from the Grain Free Certification Program
Processing Methods

Information regarding processing methods and location must be detailed. List any cleaning methods for shared machinery with grains, and pseudograins. Note: Use of shared machinery does not automatically disqualify products from the Grain Free Certification Program
UPC Codes

UPC Codes for Products meeting Grain Free Certification Standards are shared with Interested parties such as Retailers and Industry Analysts once the Certification Agreement is completed.
Product Name Product Category UPC Code
Tannins and Active Enzymes

Please list the products which contain tannins or active enzymes below.
Product Name Tannins Active Enzymes
Licensing Options
Licensing fees are assessed by companies’ gross annual revenues.
CHOOSE 3,2, OR 1 YEAR OPTION Save time and money with a 3-year Licensing Option at a 20% discount, or a 2-year Licensing Option at a 10% discount.*

CHOOSE 3,2, OR 1 YEAR OPTION
Save time and money with a 3-year Licensing Option at a 20% discount, or a 2-year Licensing Option at a 10% discount.
- 3 Year
- 2 Year
- 1 Year
- Fee Band
- I
- II
- III
- IV
- V
- VI
- VII
- VIII
- IX
- X
- XI
- XII
- XIII
- XIV
- Annual Revenues
- Up to $100,000
- Up to $500,000
- Up to $1,000,000
- Up to $5,000,000
- Up to $10,000,000
- More than $10,000,000
- More than $20,000,000
- More than $50,000,000
- More than $75,000,000
- More than $100,000,000
- More than $200,000,000
- More than $500,000,000
- More than $750,000,000
- More than $1 Billion
- Annual Fee
- $4,000
- $5,000
- $6,000
- $7,000
- $8,000
- $9,000
- $10,000
- $15,000
- $20,000
- $25,000
- $30,000
- $35,000
- $40,000
- $45,000
1. Please indicate your Fee Band:*
- I
- II
- III
- IV
- V
- VI
- VII
- VIII
- IX
- X
- XI
- XII
- XIII
- XIV
Save time and 10% with a 2-year Licensing Option
- Fee Band
- I
- II
- III
- IV
- V
- VI
- VII
- VIII
- IX
- X
- XI
- XII
- XIII
- XIV
- Annual Revenues
- Up to $100,000
- Up to $500,000
- Up to $1,000,000
- Up to $5,000,000
- Up to $10,000,000
- More than $10,000,000
- More than $20,000,000
- More than $50,000,000
- More than $75,000,000
- More than $100,000,000
- More than $200,000,000
- More than $500,000,000
- More than $750,000,000
- More than $1 Billion
- Annual Fee
- $7,200
- $9,000
- $10,800
- $12,600
- $14,400
- $16,200
- $18,000
- $27,000
- $36,000
- $45,000
- $54,000
- $63,000
- $72,000
- $81,000
1. Please indicate your Fee Band:*
- I (save $800.00)
- II (save $1,000.00)
- III (save $1,200.00)
- IV (save $1,400.00)
- V (save $1,600.00)
- VI (save $1,800.00)
- VII (save $2,000.00)
- VIII (save $3,000.00)
- IX (save $4,000.00)
- X (save $5,000.00)
- XI (save $6000.00)
- XII (save $7,000.00)
- XIII (save $8,000.00)
- XIV (save $9,000.00)
Save time and 20% with a 3 year Licensing Option
- Fee Band
- I
- II
- III
- IV
- V
- VI
- VII
- VIII
- IX
- X
- XI
- XII
- XIII
- XIV
- Annual Revenues
- Up to $100,000
- Up to $500,000
- Up to $1,000,000
- Up to $5,000,000
- Up to $10,000,000
- More than $10,000,000
- More than $20,000,000
- More than $50,000,000
- More than $75,000,000
- More than $100,000,000
- More than $200,000,000
- More than $500,000,000
- More than $750,000,000
- More than $1 Billion
- Annual Fee
- $9,600
- $12,000
- $14,400
- $16,800
- $19,200
- $21,600
- $24,000
- $36,000
- $48,000
- $60,000
- $72,000
- $84,000
- $96,000
- $108,000
1. Please indicate your Fee Band:*
- I (save $2,400)
- II (save $3,000)
- III (save $3,600)
- IV (save $4,200)
- V (save $4,800)
- VI (save $5,400)
- VII (save $6,000)
- VIII (save $9,000)
- IX (save $12,000)
- X (save $15,000)
- XI (save $18,000)
- XII (save $21,000)
- XIII (save $24,000)
- XIV (save $27,000)
Calculating License Options
Base Licensing Fee:
1. Annual/ 2 Year/ 3 Year Fee Band Total:
Price: $0.00
Lab Costs:

Please Read Carefully Lab evaluations include gluten and gliadin-competitive testing. The lab costs calculated on this form include shipping, handling, personnel, and quantity discounts offered (for more than 10 products). Lab Costs for products produced in one facility are calculated on the application. If products are produced at multiple facilities, lab analysis is required for each facility and a Paleo Foundation administrator must send an invoice.

If your product(s) has already been lab-tested for gluten content within the past year, please email the results to info@paleofoundation.org and a Paleo Foundation administrator will send an invoice for gliadin-competitive testing only.

Please answer the following questions carefully:
*
- I would like to pay for my lab tests now.
- I would like to be invoiced for my lab tests separately from this application.
- I have multiple production facilities for my products.
- I have products that have been lab-tested within the last year.
2. Lab Costs Calculations Total:
Price: $0.00
Certified Paleo Application
Rush Options:

There is a $3,000.00 dollar rush fee for companies wishing to have their products rushed through the certification process within 10 business days. The 10-day rush option is not available to companies that submit more than 10 products to be reviewed at once. The rush fee does not guarantee that all applications can be rushed through, as the process depends on several factors outside of the Paleo Foundation locus of control. This includes the ingredient supplier's ability to provide the required information in a timely manner, as well as postal delays. A refund of the rush fee will be issued if the process cannot be rushed for the selected period.
3. 10 Business Day Rush Request
- YES
- NO
More Than 10 Products:

Certification for up to 10 products are included in the standard certification, each additional product is $50.00.
TOTAL:
$0.00
NOTE: Signature Required Below
Please allow approximately 8-10 weeks for the certification process to be completed. If you have a question about the status of your application, please send an email to info@paleofoundation.org

Submitting this Grain Free Certification Application does not grant authorization for the use of the logo until the application is approved. Unauthorized use of the Grain Free Certified logo is a violation of federal Trademark Laws.
*
- I agree to the above statement. All information in this application is accurate as of the date submitted.
*
- I agree to Paleo Foundation Terms & Conditions and Privacy Policy.
Applicant Signature
Name of Company
Date
MM slash DD slash YYYY
Payment Method

MasterCard
Visa
Supported Credit Cards: MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name