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Certified Paleo + Keto Certified Application
Company Name
(Company Name) seeks permission to use the "Certified Paleo" & “KETO Certified” 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
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 Renewal
Do you want to submit another product?*
- Yes
- No
1) Product Name
*
Please use one row per supplier. Use + sign to add more rows.
Ingredients Supplier Supplier email / phone
1) Upload Nutrition Facts Label for Keto Certification Calculation
Extra Notes:
Do you want to submit another product?*
- Yes
- No
2) Product Name
Ingredients Supplier Supplier email / phone
2) Upload Nutrition Facts Label for Keto Certification Calculation
Extra Notes:
Do you want to submit another product?
- Yes
- No
3) Product Name
3) Upload Nutrition Facts Label for Keto Certification Calculation
Ingredients Supplier Supplier email / phone
Extra Notes:
Do you want to submit another product?
- Yes
- No
4) Product Name
4) Upload Nutrition Facts Label for Keto Certification Calculation
Ingredients Supplier Supplier email / phone
Extra Notes:
Do you want to submit another product?
- Yes
- No
5) Product Name
5) Upload Nutrition Facts Label for Keto Certification Calculation
Ingredients Supplier Supplier email / phone
Extra Notes:
Do you want to submit another product?
- Yes
- No
6) Product Name
6) Upload Nutrition Facts Label for Keto Certification Calculation
Ingredients Supplier Supplier email / phone
Extra Notes:
Do you want to submit another product?
- Yes
- No
7) Product Name
7) Upload Nutrition Facts Label for Keto Certification Calculation
Ingredients Supplier Supplier email / phone
Extra Notes:
Do you want to submit another product?
- Yes
- No
8) Product Name
8) Upload Nutrition Facts Label for Keto Certification Calculation
Ingredients Supplier Supplier email / phone
Extra Notes:
Do you want to submit another product?
- Yes
- No
9) Product Name
9) Upload Nutrition Facts Label for Keto Certification Calculation
Ingredients Supplier Supplier email / phone
Extra Notes:
Do you want to submit another product?
- Yes
- No
10) Product Name
10) Upload Nutrition Facts Label for Keto Certification Calculation
Ingredients Supplier Supplier email / phone
Extra Notes:
Do you want to submit another product?
- Yes
- No
11) Product Name
11) Upload Nutrition Facts Label for Keto Certification Calculation
Ingredients Supplier Supplier email / phone
Extra Notes:
Do you want to submit another product?
- Yes
- No
12) Product Name
12) Upload Nutrition Facts Label for Keto Certification Calculation
Ingredients Supplier Supplier email / phone
Extra Notes:
Do you want to submit another product?
- Yes
- No
13) Product Name
13) Upload Nutrition Facts Label for Keto Certification Calculation
Ingredients Supplier Supplier email / phone
Extra Notes:
Do you want to submit another product?
- Yes
- No
14) Product Name
14) Upload Nutrition Facts Label for Keto Certification Calculation
Ingredients Supplier Supplier email / phone
Extra Notes:
Do you want to submit another product?
- Yes
- No
15) Product Name
15) Upload Nutrition Facts Label for Keto Certification Calculation
Ingredients Supplier Supplier email / phone
Extra Notes:
Do you want to submit another product?
- Yes
- No
16) Product Name
16) Upload Nutrition Facts Label for Keto Certification Calculation
Ingredients Supplier Supplier email / phone
Extra Notes:
Do you want to submit another product?
- Yes
- No
17) Product Name
17) Upload Nutrition Facts Label for Keto Certification Calculation
Ingredients Supplier Supplier email / phone
Extra Notes:
Do you want to submit another product?
- Yes
- No
18) Product Name
18) Upload Nutrition Facts Label for Keto Certification Calculation
Ingredients Supplier Supplier email / phone
Extra Notes:
Do you want to submit another product?
- Yes
- No
19) Product Name
19) Upload Nutrition Facts Label for Keto Certification Calculation
Ingredients Supplier Supplier email / phone
Extra Notes:
Do you want to submit another product?
- Yes
- No
20) Product Name
20 Upload Nutrition Facts Label for Keto Certification Calculation
Ingredients Supplier Supplier email / phone
Extra Notes:
New Products Being submitted for Paleo + Keto Certification
Skip this section if no new products are being submitted for certification at this time. You can always submit a new product at a later time.
Product Name
*
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 for Paleo + Keto Certification?
- Yes
- No
Title
*
Ingredients Supplier Supplier email / phone
Extra Notes:
Do you want to submit another product for Paleo + Keto Certification?
- Yes
- No
Title
*
Ingredients Supplier Supplier email / phone
Extra Notes:
Do you want to submit another product for Paleo + Keto Certification?
- Yes
- No
Title
*
Ingredients Supplier Supplier email / phone
Extra Notes:
Do you want to submit another product for Paleo + Keto Certification?
- Yes
- No
Title
*
Ingredients Supplier Supplier email / phone
Extra Notes:
Do you want to submit another product for Paleo + Keto Certification?
- Yes
- No
Title
*
Ingredients Supplier Supplier email / phone
Extra Notes:
Do you want to submit another product for Paleo + Keto Certification?
- Yes
- No
Title
*
Ingredients Supplier Supplier email / phone
Extra Notes:
Do you want to submit another product for Paleo + Keto Certification?
- Yes
- No
Title
*
Ingredients Supplier Supplier email / phone
Extra Notes:
Do you want to submit another product for Paleo + Keto Certification?
- Yes
- No
Title
*
Ingredients Supplier Supplier email / phone
Extra Notes:
Do you want to submit another product for Paleo + Keto Certification?
- Yes
- No
Title
*
Ingredients Supplier Supplier email / phone
Extra Notes:
Do you want to submit another product for Paleo + Keto Certification?
- Yes
- No
Title
*
Ingredients Supplier Supplier email / phone
Extra Notes:
Do you want to submit another product for Paleo + Keto Diet Certification?
- Yes
- No
Title
*
Ingredients Supplier Supplier email / phone
Extra Notes:
Do you want to submit another product for Paleo + Keto Diet Certification?
- Yes
- No
Title
*
Ingredients Supplier Supplier email / phone
Extra Notes:
Do you want to submit another product for Paleo + Keto Diet Certification?
- Yes
- No
Title
*
Ingredients Supplier Supplier email / phone
Extra Notes:
Do you want to submit another product for Paleo + Keto Diet 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, 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* File upload
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
- 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
- Annual Fee
- $5,000
- $6,000
- $7,000
- $8,000
- $9,000
- $10,000
- $11,000
- $12,000
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)
Save time and 10% with a 2-year Licensing Option
- Fee Band
- I
- II
- III
- IV
- V
- VI
- VII
- VIII
- 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
- 2-Year Fee
- $9,000
- $10,800
- $12,600
- $14,400
- $16,200
- $18,000
- $19,800
- $21,600
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)
- VII (save $18,400.00)
Save time and 20% with a 3 year Licensing Option
- Fee Band
- I
- II
- III
- IV
- V
- VI
- VII
- VIII
- 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
- 3-Year Fee
- $12,000
- $14400
- $16,800
- $19,200
- $21,600
- $24,000
- $26,400
- $28,800
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)
Calculating License Options
Base Licensing Fee:
1. Annual/ 2 Year/ 3 Year Fee Band Total:
Price: $0.00
Certified Paleo Application
Total Do you want to submit another product.
Price: $0.00
Paleo + Keto Certified Rush Orders:

There is a $2000.00 rush fee for companies wishing to have their new products rushed through the Paleo and KETO certification process within 10 business days and a $3,000.00 rush fee for companies with 2 business day rush orders. Two business day rush is generally 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 provide the documentation promptly. 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. Two business day Rush (additional $3,000.00)
- 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
Products Being submitted for Renewal

New Products being submitted for Certification

Skip this section if no new products are being submitted for certification at this time. You can always submit a new product at a later time.
*
- 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
Date Format: MM slash DD slash YYYY

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