Document No: Non-GMO Application 100 Version 2
Revision Date: 11/24/2015
Where Food Comes From, Inc.
Non-GMO Project Verification Application
ORGANIZATION INFORMATION
Legal Name of Company/
Brand Owner
Primary Contact for NonGMO Verification
Mailing Address
Physical Address of Each
Location to Verify
(Ex: Farms, Feed Mills,
Processing Facilities, etc.)
Telephone
Email
Fax
Please describe your operation and the types of facilities that you are seeking verification for.
Ex: Farm, Livestock, Feed Mill, Ingredient Supplier, Co-packer, Handler, Processing facility, etc.
Please list all products you wish to verify and attach product labels or ingredient statements.
**Labels or ingredient statements must be submitted prior to receiving a cost estimate.
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Document No: Non-GMO Application 100 Version 2
Revision Date: 11/24/2015
Where Food Comes From, Inc.
Non-GMO Project Verification Application
VERIFICATION INFORMATION
1.
Have you ever applied for Non-GMO Project verification or been verified as a Non-GMO operator in the past?
Yes _____
No _____
If yes, which technical administrator (T.A.) have you used? Which year(s)? ________________________________
**If yes to the above, submit a copy of your most recent certificate (if applicable), inspection report (if applicable) or
similar evaluation from your previous technical administrator.
2.
If you have been previously or are currently verified, do you have verified product inventory in storage?
Yes ______
No ______
If yes, list all products and quantities:
3.
Are any or all products currently certified organic?
If yes, please list:
Yes _____
4.
Are your ingredient suppliers or feed mills currently approved under organic or Non-GMO programs?
Yes ____
No ____
5.
Do your manufacturing or packaging facilities have Identity Preservation Systems in place? If so, please list the system
and the location in which it is used. Ex: Organic, SQF, BRC, etc.
6.
Does your product contain any of the following common ingredients derived from GMO high-risk crops listed below?
Please Circle:
Amino Acids, Aspartame, Ascorbic Acid, Sodium Ascorbate, Vitamin C, Citric Acid, Sodium
Citrate, Ethanol, Flavorings (“natural” and “artificial”), High-Fructose Corn Syrup, Hydrolyzed
Vegetable Protein, Lactic Acid, Maltodextrins, Molasses, Monosodium Glutamate, Sucrose,
Textured Vegetable Protein (TVP), Xanthan Gum, Vitamins, Yeast Products.
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No _____
Document No: Non-GMO Application 100 Version 2
Revision Date: 11/24/2015
Where Food Comes From, Inc.
Non-GMO Project Verification Application
7.
Does your product contain High-risk ingredients? Yes _____
Please select all high risk crops and inputs listed below:
High Risk Crops:
No _____
High Risk Inputs:
___ Alfalfa
___ Papaya
___ Animal derivatives (eggs, dairy, meat, etc.)
___ Canola
___ Soy
___ Livestock production inputs
___ Corn
___ Sugar Beets
___ Microbes and microbial products
___ Cotton
___ Zucchini
___ Edamame
___ Honey
___ Ingredients derived from the high-risk
crops or livestock/animal products
___ Summer Squash
8.
Please let us know if you would like additional information about other certification programs offered by Where
Food Comes From, Inc. that can be bundled with your Non-GMO Project Verification.
____
____
____
____
____
____
____
____
____
____
Organic Certification
Food Alliance Certified
Global Animal Partnership (GAP) 5-Step Animal Welfare Rating
Feed Verified
Grass-fed Beef
Food Safety (SQF)
Gluten Free Certification
Non-GMO Testing SOP Development/Consulting
Where Food Comes From Source Verified ®
Other _____________________________________________
Please return completed applications to:
Where Food Comes From
221 Wilcox St., Suite A
Castle Rock, CO 80104
Office: (866) 395-5883
Fax: (877) 258-4535
Email: [email protected]
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