Δ *Important Notice for Renewing Licensees*: License renewal applications are due annually. If a renewal application is submitted after the deadline, ROA will automatically issue an invoice for the maximum licensing fee tier as outlined in the Cost and Fee Structure policy. Adjustments to fees will be made only after all required documentation is received and reviewed. Failure to submit required documentation may result in delays or suspension of your license. In this form you will need to submit the following documents (if applicable): Product Claim Material Worksheet Organic Certificate(s): Please attach your organic certificates for processing/handling, as applicable. Please include any appendices and/or client profiles. Brand/Processor License Agreement OR Private Label Retailer License Agreement ROSP for Licensed Products SCA Declaration Forms for each actor in your supply chain: Supply Chain Actor Disclosure Labels, if applicable (drafts if available) Section 1 - GeneralBusiness Name(Required)Please copy exactly as it appears on your current ROA License Your Name(Required) First Last Your Email(Required) Business Role(Required)Select all that apply Brand Processor/Handler Textile Manufacturer Textile Gin Distributor Exporter Private Label Manufacturer Retailer Other If Other, please describe your supply chain role.(Required)Private Label Retailer's Business Name(Required)Private Label Retailer's Email(Required)Private Label Retailer's Phone Number(Required)Please select the section of the Cost and Fee Structure that applies to this application(Required)View our Cost and Fee Structure policy for details on these sections. 3.1 Brand License 3.1 Brand License (strictly supplying to a private label brand owner) 3.2 Textile Brand License 3.5 Handlers/Processors/Brokers/Textile Manufacturers (Supply Chain Actor License) 3.3 Private Label Retailer Per our Terms and Definitions: Brand Owner: A person or company who sells a commodity or product under a registered brand label. Aligns with the Section 3.1 and 3.2 options Supply Chain Actor: Any organizations that process or handle certified product that are not fully packaged or contained and/or take legal ownership of ROC product; including but not limited to any stage in the supply chain where ROC materials (i.e., plant or animal products) from the producer are modified, which may include the final stage of production. Aligns with Section 3.5Do you take ownership of Regenerative Organic Certified® ingredient(s) then sell it with Regenerative Organic Certified® claims to more than one entity?(Required) Yes No *PLEASE NOTE* If you answered "No", then you may not need to complete this application! Unless you are a textile cotton gin, you are not required to complete this application if only selling to one entity unless you would like to be independently licensed anyways. If you answered "No" above, are not a textile cotton gin, and do not desire to maintain your licensed status, then please work with the brand owner that you are supplying to complete a disclosure form. They will need this form for their application. Textile cotton gins should complete this application regardless of the number of entities that they sell to. However, license fees are waived for textile cotton gins making ROC sales to only one entity.Section 2 - Updates/Changes1. Has your business name changed?(Required) Yes No Please provide new business name(Required)Upload Your Current Organic Certificate (USDA NOP/equivilent, GOT, OCS)(Required) Drop files here or Select files Accepted file types: pdf, jpg, png, Max. file size: 5 MB, Max. files: 2. Upload New Brand/Processor License Agreement(Required) Brand/Processor License Agreement can be downloaded from the Brands and Suppliers section of the RegenOrganic.org/Resources. Here is a quick link: Brand/Processor License Agreement Drop files here or Select files Accepted file types: pdf, jpg, png, Max. file size: 5 MB, Max. files: 10. 2. Has your DBA (doing business as) name changed?(Required) Yes No Please provide new DBA name(Required)Upload Your Current Organic Certificate (USDA NOP/equivilent, GOT, OCS)(Required) Drop files here or Select files Accepted file types: pdf, jpg, png, Max. file size: 5 MB, Max. files: 2. Upload New Brand/Processor License Agreement(Required) Brand/Processor License Agreement can be downloaded from the Brands and Suppliers section of the RegenOrganic.org/Resources. Here is a quick link: Brand/Processor License Agreement Drop files here or Select files Accepted file types: pdf, jpg, png, Max. file size: 5 MB, Max. files: 10. 3. Has your address changed?(Required) Yes No New Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country 4. Are there any changes to your contact information?(Required) Yes No Please let us know which contact(s) have changed:(Required) Select all that apply Legally Responsible Representative (CEO, COO, Executive Director, Managing Director, or Registered Agent) Primary Contact (one person in your Organization to be the ROA’s Primary Contact) Accounting Contact (the primary contact that should be invoiced for the organization’s License Fees) Additional Contacts (additional contacts in organization authorized to make changes, submit label reviews etc.) Legally Responsible Representative Name(Required) First Last Legally Responsible Representative Phone Number(Required)Legally Responsible Representative Email(Required) Primary Contact Name(Required) First Last Primary Contact Phone Number(Required)Primary Contact Email(Required) Accounting Contact Name(Required) First Last Accounting Contact Phone Number(Required)Accounting Contact Email(Required) Additional Contact Name #1(Required) First Last Additional Contact Phone Number #1(Required)Additional Contact Email #1(Required) Additional Contact Name #2 First Last Additional Contact Phone Number #2Additional Contact Email #2 5. Are you adding or updating your current products? (updates include UPC’s, product name, formulation, etc.)(Required) Yes No Upload New Product Claimed Material Worksheet(Required) Claimed Materials Worksheet can be downloaded from the Brands and Suppliers section of the RegenOrganic.org/Resources. Here is a quick link: Claimed Material WorksheetAccepted file types: pdf, xls, xlsx, csv, Max. file size: 5 MB.6. Is your supply chain map changing?(Required) Yes No Upload New Product Claimed Material Worksheet (sheet #4 on worksheet)(Required) Claimed Materials Worksheet can be downloaded from the Brands and Suppliers section of the RegenOrganic.org/Resources. Here is a quick link: Claimed Material WorksheetAccepted file types: pdf, xls, xlsx, csv, Max. file size: 5 MB.7. Do you have new supply chain actors?(Required) Yes No List the name(s) of your new supply chain actors(Required)Upload Supply Chain Actor Organic Certificates For New Actors(Required) Drop files here or Select files Accepted file types: pdf, jpg, png, Max. file size: 5 MB, Max. files: 2. Upload Supply Chain Actor Disclosure Form(s) For New Actors(Required) The Supply Chain Actor Disclosure Form can be downloaded from the Brands and Suppliers section of the RegenOrganic.org/Resources. Here is a quick link: Supply Chain Actor Disclosure Form Drop files here or Select files Accepted file types: pdf, jpg, png, Max. file size: 5 MB, Max. files: 10. 8. Do you have any new or updated labels? Yes, I have updated labels No, I don't have updated labels Upload Labels, including all sides(Required) Drop files here or Select files Accepted file types: pdf, jpg, png, Max. file size: 5 MB. Section 3 - Billing Details & FeesPlease provide the email address for all individuals that you want to receive our invoices. Only enter one email address in each provided field, with up to four possible. Additional fields will appear as needed.Invoice Recipient Email #1(Required) Invoice Recipient Email #2 Invoice Recipient Email #3 Invoice Recipient Email #4 Do you want a different address used on invoices?(Required) Yes No Billing Address for Invoices(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country For additional context on the following question(s), see our Cost & Fee policy. Refer to the section that aligns with the operation type as selected at the beginning of this application - Sections 3.1, 3.2, or 3.5. Fee calculations differ based on this being your first year vs. renewal.Please enter the FOB value (in US Dollars) from the previous calendar year for products WITH 50% OR MORE Regenerative Organic Certified® content. Only include the FOB value related to products on which you made ROC label claims.(Required)Please enter the FOB value (in US Dollars) from the previous calendar year for products with LESS THAN 50% Regenerative Organic Certified® content. Only include the FOB value related to products on which you made ROC label claims.(Required)Please enter the gross revenue earned (in US Dollars) from the previous calendar year for products with 70% OR MORE Regenerative Organic Certified® content. Only include the value related to products on which you made ROC label claims.(Required)Please enter the gross revenue earned (in US Dollars) from the previous calendar year for products with LESS THAN 70% Regenerative Organic Certified® content. Only include the value related to products on which you made ROC label claims.(Required)Please enter the gross revenue earned (in US Dollars) from the previous calendar year from the sale of Regenerative Organic Certified® products. Only include the value related to products on which you made ROC label claims.(Required)Is the company's anticipated annual gross revenue (including Regenerative Organic Certified® and non-certified products) $2 million or more?(Required) This determines the assessment of our Annual Membership Fee, which is detailed in Section 3.3 of our Cost & Fee policy. Yes No FacebookThis field is for validation purposes and should be left unchanged.
