Legal Name of Operation

Name of Parent Company, if applicable.

Trade names or ‘doing business as’ names, if applicable.

Name of Authorized Representative/Title

Mailing Address: Enter the legal mailing address of the operation. This may be a PO Box or street address. Include suite or apt # if applicable. Provide City, State, Postal Code, and Country

Phone #

Email

Does the authorized representative manage organic production and/or handling?

Is/has the authorized representative ever been a responsibly connected party for any certified organic operation? Responsibly Connected: Any person who is a partner, officer, director, holder, manager, or owner of 10 percent or more of the voting stock of an applicant ora recipient of certification oraccreditation.

If the authorized representative of this operation owns or partially owns any other business entities involved in agriculture and food (organic or non-organic), list them here.

Alternate Contact/Title

Phone # of Alternate Contact

Email for Alternate Contact

Overview of the operation: Crop producers: Include organic and non-organic acreage; Handlers: include types of handling i.e. co-packing, processing, distribution only; Livestock: include types of livestock and approximate numbers of each/group

Legal status of the operation:

Do you have access to a copy of the current USDA NOP standard?

If a State Organic Program applies to your operation, provide the current registration or receipt of application. All operations located in California must register with CDFA (crops & livestock) or CDPH (handlers including traders): An organic certificate cannot be issued to California operations without a current state organic program registration

Import from and/or export to: