Legal Company Name:
Email Address:
Website:
Phone #:
Fax #:
Address:
City, State, Zip Code:
Mailing Address (if different):
City, State, Zip Code:
The address listed above is a personal residence.
Contact Information:
Primary Contact
Company Name:
First & Last Name:
Title:
Address:
City, State, Zip Code:
Phone #:
Fax #:
Email:
Website:
North Carolina Food & Drug Protection Division
Animal Feed Program
New Manufacturing/Distribution Facility Registration Form
Please complete and submit this form to ncfeed.registration@ncagr.gov if manufacturing, distributing,
processing, packing, and/or holding commercial animal feed products in a facility located in the state of
North Carolina.
Firm Details:
Please fill out the following information, as applicable.
Form F_3003 (10/20)
1
New Facility Registration
Secondary /
Corporate Contact
Company Name:
First & Last Name:
Title:
Address:
City, State, Zip Code:
Phone #:
Fax #:
Email:
Website:
Product Details:
Please provide a brief description of product types.
Manufacturing/Processing Details:
Please provide a brief description of manufacturing & processing details (e.g., mixing,
baking, freezing, etc.).
Form F_3003 (10/20)
2
New Facility Registration