Company: Date:Address: City: State: Zip: Phone: E-Mail:

Product Name:

Please Provide Single Serving Weight in Grams or Ounces:Household Measure Term for Serving (ie: 1 cookie, 1 cup):# of Servings per Package:

Ingredient Brand of

Ingredient Units of Measure(in Grams, Ounces, Percentages, orHousehold Measurements)

See back of package for list of ingredients, these are the sub-ingredients.

Email or Fax Completed Form

Have Questions? CALL US TOLL-FREE From the U.S. - 877.753.6631

International - 949.309.0105 We answer our phones 7-days-a-week from 6am-9pm PST

PLEASE NOTE: When submitting this form, you are confirming that your recipe is final. Any changes made to the recipe may incur $100 change fee. We offer a 5 business day review period of your final labels, any change requests after this time may incur $100 change fee.

RECIPES NEED TO FOLLOW THIS FORMAT AND CONTAIN AS MUCH DETAIL AS POSSIBLE ABOUT EACH INGREDIENT.

Maria@RLFoodTestingLaboratory.comFax #: 877-203-4598

Contact Name:

Photos of the nutritional facts for specialty ingredients should be e-mailed along with this template.

Stock ingredients from our database will be used for any ingredient information not provided.

The client is responsible for supplying RL Food Testing Laboratory, Inc. with the accurate ingredients weights, and serving size with detail to differentiate from any common ingredient. By checking this box, you confirm you understand.

CONFIRM HERE:

RECIPE TEMPLATE ORDER FORM

If more than 1 package size, please provide additional sizes:

List all Sub-Ingredients below for all processed foods.

Where will your product be sold:

How will it be sold:

Bakery Store _____ Grocery Store _____ On-line _____ Farmers Market

Frozen _____Refrigerated _____Grocery Aisle _____Grab & Go (Deli/Bakery Item)

How is your product processed: _____ sautéed ____ boiled _____ mixed _____

Please provide initial weight _____and post weight ________ for moisture loss in baked products. Deep fried, dehydrated, fermented, brewed, filtered, pickled, marinated, contains alcohol/wine/liquor (May need Lab Analysis, speak to your RL Associate)

Restaurant menu/fast food restaurant (only provide finished serving weight in ounces or grams and recipe section for menu item)

Please check box below to accept.

baked

Please specify which type of Nutrition Label you are requesting : USA or Canada or Both

See back of package for list of ingredients, these are the sub-ingredients.List all Sub-Ingredients below for all processed foods.

Photos of the nutritional facts for specialty ingredients should be e-mailed along with this template.

RECIPES NEED TO FOLLOW THIS FORMAT AND CONTAIN AS MUCH DETAIL AS POSSIBLE ABOUT EACH INGREDIENT.

PRINT AS MANY PAGES AS NEEDED TO COMPLETE YOUR RECIPE

Ingredient Brand ofIngredient

Units of Measure(in Grams, Ounces, Percentages, orHousehold Measurements)

Stock ingredients from our database will be used for any ingredient information not provided. Please check box “Confirm Here” below to accept.