FDA Food Facility Registration Form Section 1 – TYPE OF REGISTRATION DOMESTIC REGISTRATION FOREIGN REGISTRATION INITIAL REGISTRATION BIENNIAL REGISTRATION RENEWAL If update or biennial registration renewal, provide the Facility Registration Number and PIN Facility Registration Number PIN Section 2 – FACILITY NAME / ADDRESS INFORMATION Facility Name Company Type Select Company Corporation Limited Foundation Incorporated Manufacturing Limited Liability Corporation Limited Company Non-Profit Organization Cooperative Limited Partnership Other If Other Enter: Street Address Line 1 Street Address Line 2 City State (If applicable; if not, skip to Province/Territory) Province/Territory (If applicable) ZIP or Postal Code Country Phone Number (Include Area/Country Code) FAX Number (Optional; Include Area/Country Code) E-Mail Address Section 3 – FACILITY EMERGENCY CONTACT INFORMATION Individual Name Job Title E-Mail Address Emergency Contact Phone Number (Include Area/Country Code) Section 4 – GENERAL PRODUCT CATEGORIES - Human/Animal/Both Food for Human Consumption Food for Animal Consumption Section 5 – ACTIVITY AT FACILITY Manufacturing Warehousing Repacking Re-labeling (Trading/Export only firms not required to register with FDA) Name of Foods: Submitter Name: Job Title: Submitter E-mail: Your message was sent successfully. Hello 2 You can make the annual payment online now. Domestic and all international customers pay here with 4.7% convenience fee Indian customers pay here with 18% GST
