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Form for Requesting:

Product Testing and
Nutritional Facts Panel

Thank you for your interest in the entrepreneurial assistance program at NC State University. Your products are very important to us. We are currently experiencing higher than normal volumes of phone calls, e-mails and sample submissions. As a result, we are in the process of expanding our staff to better accommodate these requests and we appreciate your patience in this time of growth. Our goal is to reduce response time and increase the personal relationship provided to our clientele more than ever before. Thank you for making NC State's food entrepreneurial assistance program one of the strongest in the nation.

Please fill out the following form and submit on-line. In fairness to all clients, we respond in the order that we receive requests. If you are requesting a product to be tested, we will contact you with information on mailing your samples.

Select one of the following:

I only want my product tested. ($100 per product)

I only want a Nutritional Facts Panel prepared for my product. ($100 per product)

I would like my product tested and a Nutritional Facts Panel prepared. ($200 per product)

If you are having a product tested, wait and send payment with the product. If you are only having a nutritional facts panel prepared, please send payment when you have submitted this form. Make check or money order payable to: NCSU Food Science

Address:	Dr. Fletcher Arritt
	North Carolina State University
	Department of Food, Bioprocessing and Nutrition Sciences
	Box 7624 Room 129 Schaub Hall
	Raleigh, NC 27695

If you have any questions or need assistance with this form, you may contact us at 919.513.2090.

Tip: Use the tab key, not the enter key, to navigate through the form. Hitting the enter key will submit your form.
Last modified: May 16, 2012

Name:

Address:
City:		State:
Zip:

Phone number:
Additional Phone number:
E-mail Address:

Company Name:
Name of Product (such as "barbeque sauce")
Product Description (such as "dried herbs in mayonnaise and cream cheese")

Note:	Please give complete information.
	Including brand names of ingredients is helpful.
	Take very accurate weights and/or measurements of each ingredient. These amounts should be for a complete batch as it is prepared. Do not do conversions.
	If you are listing weights of ingredients, you should use an accurate scale. If you are using a whole container of another product as an ingredient, you can obtain the content weight from that label. Do not confuse fluid ounces (8 fl. oz. in a cup) with weight ounces (16 ounces in a pound). They are not the same!

	Ingredient	Amount weight: lbs, oz, grams OR volume: cups, fl. oz, Tbsp, tsp	Form raw, dried, frozen, powder, bottled, canned, etc.
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Please answer the following questions:

1. What is the net weight or volume (oz. or fl. oz.) of product in the container you will be selling?
2. Is your product cooked? Yes No
3. Please give a brief description of how you process your product.

4.Will you be processing and packaging this product or will you be using a co-packer? If a copacker, which one?

5.Have you attended an acidified foods course? If so, when and where? Yes No