Go Native Retail and Restaurant FAPC Application

Fields marked with an asterisk (*) are required. To submit the form online, fill and submit the form below. To mail the form, print this page and mail the completed form to Florida Department of Agriculture and Consumer Services, Bureau of Seafood and Aquaculture Marketing, 2051 East Dirac Drive, Tallahassee, Florida 32310. The form may also be faxed to 850-922-3671.

Company Contact Information *Company Name: D/B/A: *Contact Name(s): Email Address: Website Address:

Type of Company

There are no membership fees for retail, restaurant and food service. (Please check all that apply.)*

Restaurant Food Service Retailer Internet Retailer Wholesaler

Street Address Information *Street Address: *City, State, Zip Code: *Telephone Number: Fax Number:

Mailing Address Information (if different from above) Mailing Address: City, State, Zip Code: Telephone Number: Fax Number:

Membership Information

As a member, I understand:

The Fresh from Florida Seafood (FFFS) identifier may be used on all fresh Florida seafood and aquaculture products by such persons, firms, associations or corporations who comply with the law as provided by Chapter 571, Florida Statutes.
The From Florida Seafood (FFS) identifier may be used on Florida seafood and aquaculture that are not perceived as “fresh,” including heat, frozen or chemically treated products, by firms, associations or corporations who comply with the law as provided by Chapter 571, Florida Statutes.
The GO NATIVE! identifier may be used on Florida seafood and aquaculture products.
In order to maintain the integrity of the program, it is recommended the FFFS, FFS and GO NATIVE! Identifiers be used on top quality products.
The FFFS, FFS and GO NATIVE! identifiers are registered symbols and are regulated by the Florida Department of Agriculture and Consumer Services.

By signing this application, I certify that the above information is correct and that I have received and agree to follow all guidelines of the Florida Agricultural Promotional Campaign.

Signature (Typing your name is valid as an electronic signature): Title: Date:

Restaurant/Retail Market Listing Would you like your restaurant/retail market listed on our web site? Yes No