Customer Processing Request Form

Fields marked * are required.

Company

Name

First

Last

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

BOL #

Drop off Date / Time Requested

HPP LA reserves the right to change the date based on availability ( You will be contacted with new date if change is required)

Date

Time

Drop off Temperature

Pick up Date / Time Requested

Date

Time

Number of products

Lot / Batch no

Do any of your products contain Allergens?

Is product Organic?

If yes please provide a copy of the Organic Certification if you have not done so previously.

One file, up to 4 MB.

Product types (Please add expiration date next to each product type below)

Product Information

Please list Product Name, Size (ex: 8 oz bottle), quantity, and expiration date if HPPLA is to date code

If more than 5 items please detail below

Packaging Information

Please list if you are requesting CASE PACKING or placing your product in crates. If so, deliver case packing materials/crates with product drop-off

I Verify:

A shelf life report will be on file with HPPLA for a similar product to each SKU by the date of processing

a Validation study is on file with HPPLA for a similar product to each SKU by the date of processing if required by law

We hereby certify that all statements in this application are true, accurate, and can be verified.

Title

Please enter your title in the company

Late/cancellation fees will be charged for product that is not dropped off on time.

Once product has been received HPPLA will have 1 business day to process your products, not taking into account any unforeseen Acts of God "force majeure" such as war, labor strike, riots, equipment failure.