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PHONE: (225) 342-7517 * FAX: (225) 342-7672 Rev. (11/2008) NEW COMPANY INITIAL APPLICATION Date Registration No. (For Office Use Only) Company Contact Person Taxpayer ID Telephone No. Fax No. Name of Manufacturer, Distributor, Packer, Processor, or Importer (exactly as it appears on the label) Address City State ZIP Code City State ZIP Code City State ZIP Code If this is a private-label/copacked product, list the name of the actual manufacturer here Address Name of firm subm.
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