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Company Information
Company Name
(Company Name) seeks permission to use the “Certified Paleo” Trademark, hereinafter referred to as the logo, on the attached list of product(s).
Name
Title
Signature
Date
Date Format: MM slash DD slash YYYY
*
Street Address City State / Province / Region ZIP / Postal Code Country
Phone
Website URL
Email
Products Being submitted for Certification
Product Name
*
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?*
- 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?
- 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?
- 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?
- 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?
- 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?
- 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?
- 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?
- 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?
- 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?
- 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?
- 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?
- 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?
- 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?
- 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?
- 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, legumes, and dairy. Note: Use of shared machinery does not disqualify products.
UPC Codes
UPC Codes for Products meeting Paleo Certification Standards are shared with interested parties such as Retailers and Industry Analysts once the new products have been approved.
Product Name Product Category UPC Code
Certification Programs
Select the following programs that you are applying for.
I am applying for:*
- Select All
- CERTIFIED PALEO
- KETO CERTIFIED
- GRAIN-FREE GLUTEN-FREE
RUSH OPTIONS
For new products that require expedited processing, rush options are available.
RUSH OPTIONS*
- NO RUSH FREE (4-6 week turnaround)
- 10 BUSINESS-DAY RUSH ($1,000)
- 2 BUSINESS-DAY RUSH ($2,000)
TOTAL
$0.00
NOTE: Signature Required Below
PLEASE NOTE: Submitting this application does not grant authorization for the use of the “Certified Paleo” logo until the application is approved. Unauthorized use of the “Certified Paleo” 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.
Applicant Signature
Name of Company
Date
Date Format: MM slash DD slash YYYY