Acknowledgment Of Distribution Limitations For Vfd Feeds Form printable pdf download

Acknowledgment Of Distribution Limitations For Vfd Feeds Form

Acknowledgment of Distribution Limitations for VFD Feeds

I/We hereby acknowledge that, as required by federal law, I/We shall distribute VFD feeds

received by me/us from

__________________________________________

Name of Supplier

(Consignor)

__________________________________________

Business Address

__________________________________________

City/State/Zip Code

as follows:

1. The distributor will not ship such VFD feed to an animal production facility that does not

have a VFD; or

2. The distributor will not ship such VFD feed to another distributor without receiving a similar

written acknowledgement letter; and

3. The distributor has notified the FDA of the intent to distribute VFD feed.

__________________________________________

Signature

__________________________________________

Name of Firm or Individual

(Consignee)

__________________________________________

Business Address

__________________________________________

City/State/Zip Code

__________________________________________

Date

Completed form must be sent to the consignor/supplier

Form Rev. 04/18/16

Acknowledgment Of Distribution Limitations For Vfd Feeds Form