Alternative Labeling Request Form

Company Information

Company Name
Street Address
City
State/Province
Country
Zip Code
Contact Person
Telephone
Email

Product Information

Note: Alternative labeling requests can be submitted for "product category" only when the characteristics of the product which prohibit compliance with the labeling law are pertinent to each product within the category.

Type of Product

Product Identifier - Please list by model number, series, family, etc. Indicate specific product or category of products with similar characteristics. To enter multiple products, press the "enter" or "return" key after each product to move to the next line.

Product Application

What specific requirement(s) of the rule can you NOT meet?

Cannot comply with the requirement for minimum wording or legibility of wording.
Cannot comply with the placement of the label.
Cannot comply with the visibility requirement of the rule.
Cannot comply with minimum 10 pt. font on product, package or both.

Why are you unable to meet the requirement of the law?
(please be specific)

What is your "alternative" labeling proposal?
Please identify all labeling proposed for each product or category (e.g. product, package, internet, literature). Include detail (size, material, location, attachment method, wording and font size) for each label.

If you have questions concerning this form, please contact Karen Knaebel at 802-241-3455.