Register as a Supply Chain Actor - Regenerative Organic Certified

The following must be completed by a legally authorized representative of your organization. By completing this form, the representative acknowledges that it has received, has read, fully understands, and agrees to be bound by the terms of the Regenerative Organic Certified™(ROC™) program and further agrees to comply with the ROC standards, procedures, and policies set forth in the ROC Governing Documents (available at RegenOrganic.org/Resources).

Registering with the ROA does not imply certification status. Supply Chain Actors that register with the ROA shall NOT represent themselves as certified by the ROA or certified to ROC or having established any partnership with the ROA. ROC claims are only applicable to certified product coming from a certified farm operation.

NOTE: If you will be making ROC claims or plan to use the ROC marks (the Regenerative Organic Certified™ name and all other trademarks, certification seals, logos, or any other proprietary designations owned by the Regenerative Organic Alliance) do NOT complete this form. Please complete a License Agreement (available at RegenOrganic.org/Resources).

Business Name*
Doing Business As (DBA)*
Website
Phone*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Name*
Please fill in the name of the authorized representative completing this form.
First Last
Email*
Please enter the email of the authorized representative completing this form.
The business listed above is a...*
- Processor
- Handler
- Other supply chain actor
If other, please describe supply chain role.
Does this business take legal ownership of the ROC product?*
- Yes
- No
Please list the affiliated ROC farm(s) or licensed brand(s):*
Please list the ROC products or ingredients and volumes (by weight) that you handle.*
Attach a separate list if necessary.
File upload: ROC products & volumes
Accepted file types: pdf.
Consent to Chain of Custody Guidelines*
Please confirm that you have read and understand the ROC Supply Chain Guidelines available at RengeOrganic.org/Resources. By checking this box, you agree to abide by the ROC Supply Chain Guidelines.
I agree
Cost & Fee Structure*
By checking this box you confirm that you have read the Cost & Fee Structure document (available at RegenOrganic.org/Resources) and agree to pay any applicable fees.
I agree
Directory Listing*
Do you authorize the ROA to list your business name, contact info, and services with brands, farms, or other entities looking to work with Supply Chain Actors already handling certified product?
- Yes
- No
Primary Contact Name*
Designate one person in your operation to be the Regenerative Organic Alliance’s Primary Contact. This person must be knowledgeable about your company’s engagement in the supply chain for ROC product, the ROC Supply Chain Guidelines, the ROC Program, the ROC Framework, and have the authority to act on behalf of the company.
First Last
Primary Contact Title*
Primary Contact Phone*
Primary Contact Email*
Secondary Contact Name*
Designate one person in your operation to be the Regenerative Organic Alliance’s Secondary Contact. This person must be knowledgeable about your company’s engagement in the supply chain for ROC product, the ROC Supply Chain Guidelines, the ROC Program, the ROC Framework, and have the authority to act on behalf of the company.
First Last
Secondary Contact Title*
Secondary Contact Phone*
Secondary Contact Email*
Signature*