Customer Application
This application is sent to you to obtain preliminary information, which will enable us to confirm an estimate of costs for assessment and to process any subsequent information / step as quickly as possible. The application should be completed in as much detail as possible.

Factory / Company *  
Address  
Contact Person  
Email  
Telephone Number  
Fax  


Corporate  
Address  
Contact Person  
Email  
Telephone Number  
Fax  


Broker  
Address  
Contact Person  
Email  
Telephone Number  
Fax  


Employees – Please give details of employees in the following  
a) Total in Factory  
b) Total in processing line(s): 1
Product/Style: 		 
  2
Product/Style: 		 
  3
Product/Style: 		 


Size of Factory / Facility (m 2 ):  
a) Total  
b) Production:Packaging 1
Product/Style: 		 
  2
Product/Style: 		 
  3
Product/Style: 		 
c) Cold Storage:  
Freezer:  
Warehouse:  


Scope of Assessment – Please describe the products, processes, or packages for which Assessment is sought : *  
 
How many HACCP Plans for the above products:  
 


Deletions from Scope of Assessment – Please describe the products, processes, or packages for which Assessment is not sought:  
 


Preference Period for On-Site Assessment :  
(DD/MM/YY)  


Have you used a consultant? If yes, please give details.  
 
   
Place to send quotation: Factory; Corporate Office; Broker  
   
Place to send invoices and receipts: Factory; Corporate Office; Broker  
   
Requested service (standard: ) (buyer - if applicable: )  
     
 
 

       
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