Certified Paleo, Keto Certified, Grain Free Certified Renewal Form

Company Name

(Company Name) seeks permission to use the “Grain Free Gluten Free” "KETO Certified" and "Certified Paleo" Trademarks, hereinafter referred to as the logo, on the attached list of product(s).

Name

Title

Signature

Date

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 of Paleo, Keto, and Grain Free Certification will be kept in strict confidentiality.

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.

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
$8,000
$9,000
$10,000
$11,000
$12,000
$13,000
$14,000
$19,000
$24,000
$29,000
$36,000
$39,000
$44,000
$49,000

1. Please indicate your Fee Band:*

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
$14,400
$16,200
$18,000
$19,800
$21,600
$23,400
$25,200
$34,200
$43,200
$52,200
$64,800
$70,200
$79,200
$88,200

1. Please indicate your Fee Band:*

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
$19,200
$21,600
$24,000
$26,400
$28,800
$31,200
$33,600
$45,600
$57,600
$69,600
$86,600
$93,600
$105,600
$117,600

1. Please indicate your Fee Band:*

Calculating License Options

Base Licensing Fees:

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 for your Grain Free Certification.

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. Grain Free Certification 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

TOTAL:

$0.00

NOTE: Signature Required Below

Please allow approximately 8-10 weeks for the Paleo, Keto, and Grain Free 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 Paleo, Keto, and Grain Free Certification application does not grant authorization for the use of the logos until the application is approved. Unauthorized use of the Grain Free Gluten Free 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

Payment Method

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Paleo + Keto + GF VII Renewal

We know you have choices.

We know you have choices.

Certified Paleo, Keto Certified, Grain Free Certified Renewal Form

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 Fees:

Lab Costs:

Rush Options:

TOTAL:

NOTE: Signature Required Below