<p> CSPA Consumer Product Ingredient Dictionary Application Form</p><p>Instructions: All suppliers or users of consumer specialty product ingredients may apply for approval of standard ingredient nomenclature to be included in the CSPA Consumer Product Ingredient Dictionary. Please complete a separate copy of this form for each ingredient, supplying all appropriate information, save each form as a Word document, and send it to CSPA at [email protected]. </p><p>Ingredient Description Common Ingredient </p><p>Name</p><p>INCI Name, if available </p><p>CAS Number </p><p>EC/List Number </p><p>Ingredients Listings REACH EPA Safer FIFRA Clean- Choice 25 (b) Gredients Chemical Formula </p><p>Ingredient Type Chemical Complex Proprietary Proprietary Compound Mixture Compound Mixture Technical/Other Names Trade Names Trade Name Mixtures</p><p>CSPA Consumer Product Ingredient Dictionary Application Form</p><p>Ingredient Details Source (check all that apply) Animal Plant Mineral Synthetic Bacteria, Fungi, or Other Single Cell Organism</p><p>Definition </p><p>Chemical Class(es) Ingredient Products Containing (Describe all that apply) Functions (Check all that apply) (Describe all Aerosol Products that apply) Air Care Products Antimicrobial Products</p><p>Cleaning Products</p><p>Industrial and Automotive Chemicals Pest Management Products Polishes and Floor Maintenance Products Other </p><p>VOC Status VOC LVP Exempted VOC Partial VOC, Partial LVP Non-VOC </p><p>Comments/Other Information </p><p>Suggested Nomenclature</p><p>English </p><p>French </p><p>CSPA Consumer Product Ingredient Dictionary Application Form Spanish </p><p>Company Information Company Name Phone FAX</p><p>Address</p><p>City State Zip Code Country</p><p>Web Home Page E-mail Address</p><p>Signature Printed Name Date</p><p>For CSPA Use Only CSPA Assignment Date CSPA Assignment Number</p><p>CSPA Consumer Product Ingredient Dictionary Application Form</p>