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All information must be provided.

Each Product (including flavor varieties and package sizes as sold) must be listed.
Only the items listed will be considered for certification - no general product categories will be certified

I confirm that I (print name):


is accurate as of this date:

Please name any other persons that are allowed access to this Product and Ingredient list, including their c

Highlight new products in Yellow. Highlight products you want removed from your certificate in Red. Highlig

How is this product


sold? Check all that
apply.

PRODUCT NAME (This information is


listed in public documents. List
exactly how it is shown on INDUSTRIAL- to BRAND NAME
PRODUCT UPC Code packaging) RETAIL other mfg. (Brand on label)
.
ories will be certified

have reviewed this document and that the information in Schedules A and B

dient list, including their company affiliation:

certificate in Red. Highlight product name changes or UPC changes in Blue.

Products produced in plant(s). Identify in which plant(s) this p

Who is the LEGAL Is this a PRIVATE


OWNER of this Brand LABEL or Co-MFG
name? product? Yes/No Plant: (Full Name/Address)
e information in Schedules A and B

Blue.

ed in plant(s). Identify in which plant(s) this product is made. Add additional plants as needed. Products are only cert
plants listed.

Plant: (Full Name/Address) Plant: (Full Name/Address) Plant: (Full Name/Address)


GFCO Internal Use ONLY

ed. Products are only certified in the

Product Approved for


GFCO Use*
Contingent upon
passing inspection
Plant: (Full Name/Address) and label review Date Reviewer
Source (Company making
this ingredient/ The
supplier) **Only list one
source per ingredient. If Ingredient Components: If not a
there are multiple sources single component ingredient, list
Your Company RMC/Lot Number (if please list them as all components of ingredient. "See
Name Ingredient Name used) separate ingredients** Specs" is not acceptable.
How is this
ingredient
recieved? Bags,
totes, drums,
barrels, boxes,
tankers, etc.

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