Certification Application

You can get certified by completing the form below for your company and submitting a model for certification.

Application for Certification

COMPANY INFORMATON

Company Name *

Contact Name *

Phone *

Fax

Email *

Website

COMPANY ADDRESS

Address *

City *

Zip *

State

Country *

This is company address for mailing *

Yes

No, mailing address is different

If mailing address is different, select 'No' to open new form fields for mailing address.

COMPANY MAILING ADDRESS

Address *

City *

Zip *

State

Country *

Legal Status of Company *

PRODUCT INFORMATION

Product Name and Model Number *

Brief Description of Product *

PRODUCTION FACILITY INFORMATION

Contact Name *

Phone *

Fax

Email *

Facility Address *

City *

Zip *

State

Country *

Hours of Operation

Holidays/Closings

Size of Facility (square feet)

Total Employees

Salaried

Hourly

Affidavit

By submitting this application I certify that I agree to comply with the applicable Gulf Coast Testing policies and ANSI/NSF Standards related to the use of the GCT mark. I am authorized by the company to agree that the company will pay for any charges billed for services rendered at the request of the company in the initial evaluation and/or testing of products for Certification.

A check in the amount of $500 will be sent to the Gulf Coast Testing address above for the certification application deposit. I understand that upon acceptance by Gulf Coast Testing, LLC, the deposit is non- refundable. Charges for all other services will be invoiced as rendered.

Date *

Month

Day

Year

Name *

Title *

PLEASE SEND CHECK TO:
Jill Ratcliff

GULF COAST TESTING, LLC
17732 Highland Rd, Ste G, #204
BATON ROUGE, LA 70810

MAKE CHECK PAYABLE TO GULF COAST TESTING, LLC

If you prefer a downloadable PDF form click here.

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