Facility Application Form

Certified Company Info

Name of Company Requesting New Facility.*

Kosher certified company.

Is the company terminating certification for any other facilities?*

By certifying this new facility, will the company de-certify an existing one?

Yes
No

Please tell us the name and address of the facility this will replace.*

Production Facility Information

Does the OK-certified company own the new facility?

Yes
No

Name of Owning Company:*

Address of Owning Company*

Please fill in all fields, including city, region, and postal code.

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Owning Company Contact Name*

First Last

Owning Company Contact Phone*

Owning Company Contact Email*

Enter Email Confirm Email

Facility Name*

Facility Address*

Please fill in all fields, including city, region, and postal code.

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

Nearest Airport*

Travel Time from Airport to Facility*

Please specify the recommended mode of transport (e.g. car, train, boat, helicopter, etc.)

Facility Contact

(typically regulatory personnel)

Name*

Prefix First Last

Phone*

Email*

Plant Manager

Same as Kosher Contact

Name*

Prefix First Last

Phone*

Email*

Production

Does this facility re-label products?*

Yes
No

Does this facility repack products?*

Yes
No

Does this facility produce/blend/manufacture their own products?*

Yes
No

Are any of the finished products manufactured in this facility also produced at other sites?*

Yes
No

If Yes, please list other sites:

Does this facility manufacture products for a brand that you do not own?*

Yes
No

If Yes, please provide details.

Whose ingredients are used?*

Only ingredients purchased by the company
Only ingredients purchased by the facility
Only ingredients supplied by a 3rd party

Certification

What are you requesting Kosher certification for?*

The entire facility
Only a portion of the facility

Please detail.*

Kosher service charges are based on a flat rate structure per facility, Not a variable rate plan per products! If all your products can be certified, we will be glad to certify your entire facility.

Please list all the types of manufacturing processes:

DB: Dry blend
CLC: Coat with cold liquid <115º
HLP: Hot liquid process
HLC: Coat with hot liquid >115º
CLP: Cold liquid process
Other

Please detail

Ingredient List

If available, you can submit a pre-printed inventory list, per facility, of all ingredients, with the manufacturer's name and the kosher certifying agency if available.
- If you have any kosher certificates on file, please submit them with the above list. Please ensure to mark off on the kosher letter, which ingredient you use.
- Please list ALL ingredients regardless of kosher status.
- Supported file types: .pdf, .doc, .docx, .xls, .xlsx, .csv, .tif, .tiff, .zip - For multiple files please upload a zip.

Electronic Signature*

(Terms and Conditions)

I have read and agreed with the terms and conditions above and indicate my acceptance by checking this box and by typing and entering my name in the electronic signature box below. By checking this box and by typing and entering my name below, I authorize my electronic signature to carry the same weight and legal effect as my written signature.

Companies

Certified Company Info

Production Facility Information

Facility Contact

Plant Manager

Production

Certification

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Facility Application Form

OK Certified Company Info

Production Facility Information

Facility Contact

Plant Manager

Production

Certification

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Certified Company Info