Official APPI Testing Kit Order Form Jan - Dec 2009
Join the Animal Protein Producers Industry Self-Help Salmonella Education/Reduction Program

Company Name*

Plant Code

If you are a new member, APPI will assign this to you.

Category*

Please read carefully and mark one. It is important that you are placed in the correct category.

	Independent rendering plants who process street, captive and non-captive raw material
	Packer Renderers – rendering plants whose primary tonnage is livestock by-products, captive raw material and any street and non-captive by-products makes up a very small percentage of their tonnage
	Poultry Processors – integrated poultry renderers or rendering plants whose primary raw materials are poultry by-products and any street or other type raw material makes up a very small percentage of their tonnage
	Protein Blenders - plants who do not render but purchase dry rendered tankage, bloodmeal, feather meal, and other animal or marine rendered proteins for blending an uniform animal protein product
	Renderer/Blender – plants that process raw material to rendered protein and blend the finished material to a uniform animal protein product

Contact Information

UPS Address No P.O. Boxes

Address 1*

Address 2

City, State, Zip*

Mailing Address For test results

Address 1*

Address 2

City, State, Zip*

Is the above address headquarters only and/or a participating plant?*

	Headquarters only
	Headquarters & Participating Plant
	Plant only

Phone Number*

Fax Number*

Contact Person*

Email*

Title*

Headquarters Information
Headquarters Mailing Address
Address 1*
Address 2
City, State, Zip*
Phone Number*
Fax Number
Contact Person*
Email*
Title*

Where would you like the kit(s) to be sent?*

	Above address
	Plants listed below

Where would you like test results, educational materials, and any other materials to be sent?*

	Headquarters only
	Both headquarters and each individual plant
	Individual plants only

Who should be billed for the following?*

Test Kits

	Headquarters
	Individual plant(s)

Test Results

	Headquarters
	Individual plant(s)