Company Name
Phone
Email
Web site
Company Contact Information
Contact Name
Phone
Email
Physical Address
City
Zip
Does your business file a tax return with the State of Utah?
Yes | No
Agriculture producer
Food Processor
Wholesale/Distributor
Restaurant
Packer
Other
Mailing Address
City
Zip
The Utah Department of Agriculture and Food only registers products for the use of the Utah's Own logo. The greater part of the value of the product must be derived within the State of Utah. Please provide the following product information including how the product meets Utah's high quality standards.
Product Name
% of unit value derived in Utah
Product Description
Quality Standard/Certification (Certified organic, industry awards, quality verification, etc.)
Product Name
% of unit value derived in Utah
Product Description
Quality Standard/Certification (Certified organic, industry awards, quality verification, etc.)
Product Name
% of unit value derived in Utah
Product Description
Quality Standard/Certification (Certified organic, industry awards, quality verification, etc.)
As an authorized representative for the company and products named above, I attest that the information provided is correct to the best of my knowledge. I further agree to notify the Marketing Division of the Utah Department of Agriculture and Food of any change in that would affect our product registration.
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