FV-652 Logo Use Request for Audit Programs

FORM APPROVED BY OMB No. 0581-NEW
UNITED STATES DEPARTMENT OF AGRICULTURE
Agricultural Marketing Service
Fruit and Vegetable Programs
Fresh Products Branch

LOGO USE REQUEST
FOR AUDIT PROGRAMS

FEDERAL AUTHORIZATION: This form is to be completed by authorized personnel in accordance with the specified Fresh Products Branch audit program(s). All
materials which make reference to the audit program(s) design or language are accountable items. Their use is authorized by a contract between the USDA and the
participant company. No materials shall bear reference to the audit program(s) design or language without prior written consent of the Fresh Products Branch.

A. Logo Description

FRESH PRODUCTS BRANCH

Type of Logo: □ Black □ Color**
**( GAP&GHP and IP color logos must use Pantone Matching
System (PMS) color Green 348. PIQ color logos must use the
colors red, white and blue in specified areas. Any other colors
used will not be considered an approved audit program logo and
will be in violation of the agreement.)

B. Company Information
___________________________________________
Name of Company

_______________________________________________________________
Mailing Address of Company

___________________________________________
Name and Title of Person Requesting Logo Use

_______________________________________________________________
Phone Number

C. Logo Use
Commodities:_______________________________________________________________________________________________
Select type(s) of use and specify the number of materials that will contain the audit programs logo (Attach Additional Documentation):

□ Containers : __________
□ Publication(s) __________ type(s):___________________________________________
□ Labels/Stickers __________
□ Website(s) __________ web address(es):______________________________________
□ Other : ________________________________________________________________________________________________________________
D. Manufacturer’s Information
___________________________________________
Manufacturer’s Name

___________________________________________
Manufacturer’s Phone Number

_________________________________________________________________________________________
Manufacturer’s Mailing Address
E. Applicant’s Request
As an authorized participant in the Fresh Products Branch audit program(s), I hereby request that the above materials be approved and
produced with the audit program(s) logo. I agree to be responsible for all charges assessed by the manufacturer of the materials for this
order. I also acknowledge that all materials containing the audit program(s) logo are in compliance with the audit program(s) logo use
requirements and are for the exclusive use as a participant in good standing in the audit program(s) as authorized by the USDA. A copy
of the manufacturers’ invoice bearing the exact number of preprinted materials produced with the audit program(s) logo and a signed
copy of Section F will be forwarded to the Fresh Products Branch immediately after the time of receipt.
_________________________________________
Applicant’s Signature

_______________
Date

_________________________________________
Federal Authority Signature

_______________
Date

F. Applicant’s Receipt
I have received the above listed materials and they are now my responsibility. I certify that only the materials in the above list have been
produced and will only be used in accordance with a audit program(s) in good standing.
_________________________________________
Applicant’s Signature

_______________
Date

_________________________________________
Federal Authority Signature

_______________
Date

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information
unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0581-XXXX. The time required to complete this
information collection is estimated average 0.2 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the collection of information.
The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, age, disability, and
where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal or because all or part
of an individual’s income is derived from any public assistance program. (Not all prohibited bases apply to all programs.) Persons with disabilities who require
alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA’s TARGET Center at (202)720-2600 (voice
and TDD). To file a complaint of discrimination, write to USDA, Director, Office of Civil Rights, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, or
call (800)795-3272 (voice) or (202)720-6382 (TDD). USDA is an equal opportunity provider and employer.

FV-652 (04-09)