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Form for Requesting:

Product Testing and
Nutritional Facts Panel

The lab will be closed from December 5th until January 5th.
No submissions accepted until after January 5th, 2009.

Please fill out the following form and submit on-line. If you are requesting a product to be tested, we will contact you with information on mailing your samples.

Select one of the following:

I only want my product tested. ($50 per product)

I only want a Nutritional Facts Panel prepared for my product. ($50 per product)

I would like my product tested and a Nutritional Facts Panel prepared. ($100 per product)

If you are having a product tested, wait and send payment with the product. If you are only having a nutritional facts panel prepared, please send payment when you have submitted this form. Make check or money order payable to: NCSU Food Science

Address:
	Dr. John Rushing
	North Carolina State University
	Department of Food Science
	Box 7624 Room 129 Schaub Hall
	Raleigh, NC 27695

If you have any questions or need assistance with this form, you may contact JoAnna Foegeding at 919-513-2090

Tip: Use the tab key, not the enter key, to navigate through the form. Hitting the enter key will submit your form.

Last modified: December 1, 2008

Name:

Address:
City:		State:
Zip:

Phone number:
Additional Phone number:
E-mail Address:

Company Name:
Name of Product (such as "barbeque sauce")
Product Description (such as "dried herbs in mayonnaise and cream cheese")

Note:	Please give complete information.
	Including brand names of ingredients is helpful.
	Take very accurate weights and/or measurements of each ingredient. These amounts should be for a complete batch as it is prepared. Do not do conversions.
	If you are listing weights of ingredients, you should use an accurate scale. If you are using a whole container of another product as an ingredient, you can obtain the content weight from that label. Do not confuse fluid ounces (8 fl. oz. in a cup) with weight ounces (16 ounces in a pound). They are not the same!

	Ingredient	Amount weight: lbs, oz, grams OR volume: cups, fl. oz, Tbsp, tsp	Form raw, dried, frozen, powder, bottled, canned, etc.
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Please answer the following questions:

1. In what size container will your product be packaged?
(For a jar or bottle this must be in fluid ounces.)
2. Is your product cooked? Yes No
3. Please give a brief description of how you process your product.