Where is product(s) manufactured or grown?
Product Type (select one)
Refrigerated or Frozen
Supplements, Bodycare, Housewares, bulk herbs or teas
Beer, Wine, or other spirit
Deli Prepared Items
Product Details (Check all that apply)
have Individual UPC/barcode
have Printed Nutrition Information
have Printed Allergen Information
Produced in Illinois
Product currently sold at other retailers
Additional Product Details
Documents and Permits (check all that apply)
Proof of Insurance ($2 million)
Food Manufacturing License
Allergen Control Program
Permit to Operate a Food Service Establishment
Food Manager’s Certification
Sales Tax Permit
Any other information you'd like to include.
Are there questions you feel would be appropriate on this application, or do you have a suggestion for making this form better?
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