Paleo + KETO Certification Application for Products

Certified Paleo ® + KETO Certified ® Application

There has been a lot of debate about the superiority of either the Keto Diet or the Paleo Diet, but there is no disputing the remarkable increase in popularity of these product attributes in the Natural Channels. Congratulations on beginning the journey towards optimizing your brand’s trust and sales with the synergy of a Certified Paleo and KETO Certified dual Certification program.

Certified Paleo ® + KETO Certified ® Application

Certified Paleo + KETO Certified Application
Company Name

(Company Name) seeks permission to use the “KETO Certified” 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 for certification purposes will be kept in strict confidentiality.
Products Being submitted for Paleo + KETO 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:
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 for Paleo or KETO Certification.
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 for Paleo or KETO Certification.
UPC Codes

UPC Codes for Products meeting Keto Certified Standards are shared with Interested parties such as Retailers and Industry Analysts once the Certification Agreement is completed.

Product Name	Product Category	UPC Code

Untitled
Nutrition Facts

Nutrition Facts must be submitted and analyzed for Keto Certification. Keto Diet Approved Products must meet ingredient and macronutrient standards.
Upload Nutrition Facts Label*
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
- $5,000
- $6,000
- $7,000
- $8,000
- $9,000
- $10,000
- $11,000
- $12,000
- $17,000
- $22,000
- $27,000
- $32,000
- $37,000
- $42,000
1. Please indicate your Fee Band:*
- I (save $1,000.00)
- II (save $2,000.00)
- III (save $3,000.00)
- IV (save $4,000.00)
- V (save $5,000.00)
- VI (save $6,000.00)
- VII (save $7,000.00)
- VIII (save $8,000.00)
- IX (save $13,000.00)
- X (save $18,000.00)
- XI (save $23,000.00)
- XII (save $28,000.00)
- XIII (save $33,000.00)
- XIV (save $38,000.00)
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
- $9,000
- $10,800
- $12,600
- $14,400
- $16,200
- $18,000
- $19,800
- $21,600
- $30,600
- $39,600
- $48,600
- $57,600
- $66,600
- $75,600
1. Please indicate your Fee Band:*
- I (save $3,000.00)
- II (save $5,200.00)
- III (save $7,400.00)
- IV (save $9,600.00)
- V (save $11,800.00)
- VI (save $14,000.00)
- VII (save $16,200.00)
- VIII (save $18,400.00)
- IX (save $29,400.00)
- X (save $40,400.00)
- XI (save $51,400.00)
- XII (save $62,400.00)
- XIII (save $73,400.00)
- XIIV (save $84,400.00)
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
- $12,000
- $14,400
- $16,800
- $19,200
- $21,600
- $24,000
- $26,400
- $28,800
- $40,800
- $52,800
- $64,800
- $76,800
- $88,800
- $100,800
1. Please indicate your Fee Band:*
- I (save $6,000)
- II (save $9,600)
- III (save $13,200)
- IV (save $16,800)
- V (save $20,400)
- VI (save $24,000)
- VII (save $27,600)
- VIII (save $31,200)
- IX (save $49,200)
- X (save $67,200)
- XI (save $85,200)
- XII (save $103,200)
- XIII (save $121,200)
- XIV (save $139,200)
Calculating License Options
Base Licensing Fee:
1. Annual/ 2 Year/ 3 Year Fee Band Total:
Price: $0.00
Certified Paleo Application
Paleo + Keto Certified Rush Orders:

There is a $1000.00 dollar rush fee for companies wishing to have their products rushed through the paleo and keto certification process within 10 business days and a $2,000 dollar rush fee for companies with 24-hour rush orders. 24-hour rush is not available to companies that submit more than 5 products to be reviewed at once. The rush fee does not guarantee that all applications can be rushed through as the process depends on the company and the supplier’s ability to supply the required information in a timely manner. A refund of the rush fee will be issued if the process cannot be rushed for the selected period.
2. 10 Business Day Rush Request (additional $1000.00)
- YES
- NO
3. 24-hour Rush (additional $2,000.00)
- 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 6-8 weeks for your Paleo + Keto Certification to be completed. If you have a question about the status of your application, please send an email to info@paleofoundation.org

Submitting this application does not grant authorization for the use of the logo until the application is approved. Unauthorized use of the Certified Paleo or Keto 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

Save and Continue Later

59577

Certified Paleo + KETO Certified Application

Certified Paleo ® + KETO Certified ® Application

Certified Paleo ® + KETO Certified ® Application

Certified Paleo + KETO Certified Application

Products Being submitted for Paleo + KETO Certification

Processing Methods

UPC Codes

Nutrition Facts

Licensing Options

CHOOSE 3, 2, OR 1 YEAR OPTION

Save time and 10% with a 2-year Licensing Option

Save time and 20% with a 3 year Licensing Option

Calculating License Options

Base Licensing Fee:

Paleo + Keto Certified Rush Orders:

More Than 10 Products:

TOTAL:

NOTE: Signature Required Below