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Contact Information Date: Purchase Order: Company: Contact Name: * Req. Address: * Req. Phone Number: * Req. City: * Req. Fax Number: State/Province: * Req. Email: * Req. Zip Code: * Req.     Country: United States Albania Andorra Armenia Australia Austria Azerbaijan Belarus Belgium Bermuda Bosnia Bulgaria Canada Croatia Cyprus Czech Republic Denmark Estonia Finland France Georgia Germany Greece Greenland Hungary Iceland Ireland Italy Japan Latvia Liechtenstein Lithuania Luxembourg Macedonia Malta Mexico Moldova Monaco Netherlands Norway Poland Portugal Romania Russia San Marino Serbia Slovakia Slovenia Spain Sweden Switzerland Turkey Ukraine United Kingdom       Services Requested     Nutrition Analysis Nutrient Content Claims   Nutrition Facts Label   Package Label Review   Supplement Facts Label   Shelf Life Review   Ingredient Statement   PIS Form (School foodservice only) Allergen Declaration UPC Bar Code   *FDA Compliance Package Rush Service: None 1 Day (add 100%) 2 Days (add 75%) 3 Days (add 50%) 4 Days (add 25%)   *Includes: Nutrition Analysis, Nutrition Facts Label, Ingredient Statement, and Package Label Review. Laboratory Analysis: None Moisture Nutrition Analysis Peroxide Pet Food Analysis pH Plate Count Shelf Life Testing Water Activity (aW) Yeast and Mold Other     Other: Product Information     Item Name: Unit/Piece Weight: - g oz lbs     Units per Package:         Additional Pack Sizes: - g oz lbs Volume: - fl oz pint quart gallon liter milliliter       - mL liter   Product Formulation       Ingredient Type Description Preparation 1 Pick One Raw/Fresh Dried/Dehydrated Canned/Bottled Frozen Cooked Other Pick One Purchased Prepared In-House Recipe Other (please specify) 2 Pick One Raw/Fresh Dried/Dehydrated Canned/Bottled Frozen Cooked Other Pick One Purchased Prepared In-House Recipe Other (please specify) 3 Pick One Raw/Fresh Dried/Dehydrated Canned/Bottled Frozen Cooked Other Pick One Purchased Prepared In-House Recipe Other (please specify) 4 Pick One Raw/Fresh Dried/Dehydrated Canned/Bottled Frozen Cooked Other Pick One Purchased Prepared In-House Recipe Other (please specify) 5 Pick One Raw/Fresh Dried/Dehydrated Canned/Bottled Frozen Cooked Other Pick One Purchased Prepared In-House Recipe Other (please specify) 6 Pick One Raw/Fresh Dried/Dehydrated Canned/Bottled Frozen Cooked Other Pick One Purchased Prepared In-House Recipe Other (please specify) 7 Pick One Raw/Fresh Dried/Dehydrated Canned/Bottled Frozen Cooked Other Pick One Purchased Prepared In-House Recipe Other (please specify) 8 Pick One Raw/Fresh Dried/Dehydrated Canned/Bottled Frozen Cooked Other Pick One Purchased Prepared In-House Recipe Other (please specify) 9 Pick One Raw/Fresh Dried/Dehydrated Canned/Bottled Frozen Cooked Other Pick One Purchased Prepared In-House Recipe Other (please specify) 10 Pick One Raw/Fresh Dried/Dehydrated Canned/Bottled Frozen Cooked Other Pick One Purchased Prepared In-House Recipe Other (please specify) 11 Pick One Raw/Fresh Dried/Dehydrated Canned/Bottled Frozen Cooked Other Pick One Purchased Prepared In-House Recipe Other (please specify) 12 Pick One Raw/Fresh Dried/Dehydrated Canned/Bottled Frozen Cooked Other Pick One Purchased Prepared In-House Recipe Other (please specify) 13 Pick One Raw/Fresh Dried/Dehydrated Canned/Bottled Frozen Cooked Other Pick One Purchased Prepared In-House Recipe Other (please specify) 14 Pick One Raw/Fresh Dried/Dehydrated Canned/Bottled Frozen Cooked Other Pick One Purchased Prepared In-House Recipe Other (please specify) 15 Pick One Raw/Fresh Dried/Dehydrated Canned/Bottled Frozen Cooked Other Pick One Purchased Prepared In-House Recipe Other (please specify) 16 Pick One Raw/Fresh Dried/Dehydrated Canned/Bottled Frozen Cooked Other Pick One Purchased Prepared In-House Recipe Other (please specify) 17 Pick One Raw/Fresh Dried/Dehydrated Canned/Bottled Frozen Cooked Other Pick One Purchased Prepared In-House Recipe Other (please specify) 18 Pick One Raw/Fresh Dried/Dehydrated Canned/Bottled Frozen Cooked Other Pick One Purchased Prepared In-House Recipe Other (please specify) 19 Pick One Raw/Fresh Dried/Dehydrated Canned/Bottled Frozen Cooked Other Pick One Purchased Prepared In-House Recipe Other (please specify) 20 Pick One Raw/Fresh Dried/Dehydrated Canned/Bottled Frozen Cooked Other Pick One Purchased Prepared In-House Recipe Other (please specify)   Preparation Method:   (I.E. baked, cold fill, cooked covered, uncovered, etc.) Please be as detailed as possible.             Additional questions, comments, or special instructions: