Organic System Plan – Class OR (Retail) Organic ... - Oregon Tilth

Retail Application
Primary Contact Information
Name of person applying for certification:
Please select the appropriate legal description of the applicant and provide the corresponding
information as requested.
¨ Sole Proprietor
¨ Partnership
Business Name (DBA):
Address:
(Street, City, State or
Province and zip code)
Website:
Proprietor / Partner Name:
Phone Number(s):
Email Address:
Partner Name (if necessary):
Phone Number(s):
Email Address:
¨ Limited Liability Corporation (LLC)
¨ Corporation
¨ Trust / Other Organization
Legal Address:
(Street, City, State or
Province and zip code)
Website:
Primary:
Mobile:
Office:
Fax:
Primary:
Mobile:
Office:
Fax:
Executive Director, Managing Director,
or Registered Agent:
Phone Number(s):
Email Address:
Organic Compliance Manager:
(if applicable)
Phone Number(s):
Primary:
Mobile:
Office:
Fax:
Primary:
Mobile:
Office:
Fax:
Email Address:
Please attach a listing of all officers/shareholders, office/shareholder contact information, and/or articles
of incorporation
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