A1 General Information

ECOCERT ICOPage 1 of 3

A1 – General Information
Name of Operation(please indicate any DBA names or aliases):
Name and Title of Main contact
Name and Title of additional contact
Name and Title of additional contact
Address of site to be certified:
Address line 1: / City:
Address line 2: / State: / Zip:
Directions to site to be certified (List details to help the inspector locate your operation):
Mailing address (if different than site address):
Address line 1: / City:
Address line 2: / State: / Zip:
Phone number(s): / Email address:
Fax number: / Website:
Communication preferences:
Phone / Email / Fax / Mail
Is email a reliable means of communicating with you? / No / Yes
Availability for contact:
Indicate preferred weekdays below: / Morning / Afternoon / Evening
List any period of time when the annual inspection cannot be conducted (such as facility operating hours, operator availability, etc.):
In the space below, please provide a brief summary description of your operation, including any special features or unique circumstances.
Example 1: We grow commodity row crops on rolling countryside without irrigation, using on-farm manure.
Example 2: I have 5 acres of assorted vegetables that I sell at local farmers markets and through a CSA.
Example 3: We produce body lotions with organic ingredients and sell exclusively at regional farmers markets.
Do you have an updated copy of the USDA Organic Standards? You can click here to get the latest one. / No / Yes
Have you read the current USDA Organic Standards? / No / Yes
Do you understand the current organic standards for the certification type(s) you are requesting? / No / Yes
Have you read the Certification Process (available here) / Yes
By checking this box you agree to terms and conditions (available here) / Yes
How did you hear about Ecocert ICO? Referral Describe:
Internet Conference/PresentationDescribe:
Other Describe:
Do you need information on any additional services or one-stop inspections? / No / Yes
If yes, please identify the service you are interested in:
USDA NOP Equivalency – Shipping outside of U.S.: Europe/Switzerland, Korea, Japan/Taiwan, Canada
Fair for Life -Fair Trade Ecocert Organic Cosmetic / NSF Personal Care Standard GlobalGAPUTZ Certified (Coffee, Cocoa, Tea..)
AquacultureMarine Stewardship CouncilAquaculture Stewardship Council
Other Describe:
I have enclosed the application fee in the amount of $ .
I have made copies of this questionnaire and other supporting documents for my own records.
I am authorized to sign on behalf of the applicant/Company.
I am at least 18 years of age on the date of signature below and authorized to sign on behalf of the applicant/Company

This page must be signed and included with your Organic System Plan (OSP) in order to complete your application.

If you are submitting this form electronically, you understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature. By typing your name below you are agreeing to this statement and electronically signing this form.

Signature of Owner/Operator :
Printed Name: Title: / Date:
For Office Use Only
Application fees: / NOPID:
Application fees entered: / Initial:
Application forms entered:
Approval / Form code / Last update
QM / A1 (v5) / 03/19/18

If you have questions, we are happy to help. Please call: 1-888-337-8246. Submit your application at / Fax: 317-708-0628