FDA Registration Payment Form for Mid-Year Change

Mid-Year Change Fee | $205

FDA Registration Fee = $195
Processing Fee = $10

Inspection Confirmation(Required)
On behalf of the above named facility, I authorize Diaz Trade Consulting, LLC to be our U.S. agent for the purpose of communicating with the U. S. Food and Drug Administration (FDA) in accordance with our U. S. Bioterrorism Act (BTA) Registration. I acknowledge that the FDA has full authority to inspect our facility, and if my company chooses not to let the U.S. FDA inspect our facility, we risk FDA cancelling our BTA registration and not having the ability to sell our products in the U.S. By signing below, I confirm that my company, successors and assigns are solely responsible and will take full responsibility for any and all costs incurred by the FDA as a result of any "re-inspections", recalls or services performed by the FDA pursuant to our BTA registration.

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