FDA Importer Registration Form

FDA Importer Registration Form
Please complete this form to register as an importer with the FDA. All information provided will be used for compliance and communication purposes.
Importer Business Name
Importer Business Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Business Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Business Email Address
example@example.com
Responsible Contact Person (Full Name)
First NameLast Name
Facility Name (if different from Importer)
Facility Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Facility Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Types of Products to be Imported
Other
FDA Registration Number (FEI Number, if available)
Emergency Contact Name
First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Intended Use of Imported Products
Signature of Authorized Representative
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