Production Request Form Company Name* Contact Person* Address* City* State/Province* Zip/Postal Code* Preferred Telephone #:* Email:* Website: Product Type:* Product Name:* Formula Provided?* YesNo Prototype or Benchmark?* PrototypeBenchmark How did you hear about us?* For Product Development Clients: To initiate product development, the PDR and starter info jacket must be completed and returned along with payment in the amount of $1,750.00. This fee includes up to three (3) prototype submissions per product. This deposit is non-refundable. If none of these submissions are accepted (and/or further product development is requested, additional hourly rates at $100/hr will apply). If the product desired is a "stock formula" item, with only minor adjustments to fragrance and/or color, a fee of $75-$125 is required. For Contract Manufacturing Clients: Clients providing a formula for their product are required to provide a master sample. A non-refundable deposit of $1,500.00 is due at the time of request. This fee covers any laboratory time required to prove the formula. If the client requires further development, the Custom Product Development fee ($1,750.00) is applicable, minus $500.00 of the initial deposit. Please note this is based on stock ingredients. Sample Payment All payments are due in full at the time that this form is submitted. Payments can be made by credit or debit card, PayPal, invoice or company checks. Formula Advice LifeOrganics prides itself on using the highest quality natural and organic ingredients that are pure and effective. Regulatory statuses are continually changing which may have an effect on the ingredients. We will advise every customer if their product(s) requested for manufacture contain ingredients that are affected by FDA regulatory changes. **Note: Product samples may take up to six weeks or longer depending on our current projects intake, raw materials and their availability. Clients requiring special raw ingredients and/or fragrances that are not in our current inventory will solely be responsible for purchasing those raw materials and/or fragrances in order to make their project sample, unless requested otherwise by client. Product Profile Please fill out the following to initiate laboratory time: Description:* Attributes: Form?* LiquidGelCremeLotionPasteOther Appearance?* ClearPearlyOpalescentOpaque Color?* WhiteGreenBlueYellowBrownOther *Note: it is preferrable if samples or benchmarks are provided for color standards. Fragrance: Will this product contain a fragrance?* YesNo If yes, do you have fragrance samples that are to be used or matched? Performance Describe how you want the product to perform:* Describe the attributes of the product to claim (all natural, specialty ingredients, etc.):* Target Customers and/or Market Gender:* MaleFemale Ethnicity:* African-AmericanEuropeanHispanicNative-AmericanCaucasian Market:* ProfessionalRetailGeneralOther Price range to purchase product from us:* Price range to sell product:* Components Container:* Bottle/TubeJar Size:* 2 oz4 oz8 oz16 oz32 oz64 ozOther Color:* WhiteNaturalClear Closure:* CapPumpSprayDispenseOther Please type what type of closure to use: Check all that apply that your company currently has:* LogoContact InfoWebsite1(800) #Label DesignLabels Activities that LifeOrganics will provide/perform:* FillLabelingKitting & AssemblyShrink WrapManufactureProductionBoxesComponents Use this space for any additional information: Proposed Start Date:* Projected Initial Order Quantities: Estimated Volume per year: Typing in your name in the Signature field and today's date in the Date field will act as your signature as it relates to this form. Signature* Date*