<p> Bord Bia Horticultural Quality Assurance Scheme Registration Form</p><p>BLOCK CAPITALS ONLY PLEASE</p><p>Company Name Producer Number: To appear on certificate if applicable For office use only Contact Dept. Reg No.</p><p>Position New Applicant Please  Please tick Grower Grower- Packer Distributor Prepared</p><p>Please list additional sites on the back Postal Address Site 1 Address Tel: Mob: Fax: Email: This Section is for Grower & Grower Packer</p><p>Please tick  SECTOR: Potatoes Field Vegetables Fruit Protected Crops Mushrooms Amenity</p><p>CROP/s - PLANTS Acres Planted 1 2 3 4 5</p><p> I/We agree to allow right of access to all areas and relevant personnel for the inspector to carry out inspections and agree to provide documentation and records required for examination.  I understand that Bord Bia reserves the right to inform the relevant authority in the event that information becomes available in the course of an audit which could lead to a food safety or health & safety issue.  I understand that the validity of my certificate can only be checked through the Bord Bia web based service (validity of certificates and current approval status) and this facility is publicly available.  I have access to a copy of the standard and understand the scheme rules.  I am committed to complying with the requirements for certification.</p><p>. SIGNATURE:______DATE:______</p><p>See Schedule of Charges on Reverse. Application Fee Enclosed Yes/No (Delete as appropriate) </p><p>See Reverse Additional Sites: Site 2 Postal Postal Postal Site 3 Directions Postal Postal Postal Directions</p><p>Directions from Nearest Town</p><p>Please  Audits Available Grower Packer Audit (BB) €350.00 plus Vat €430.50 Ornamental Audit €350.00 plus Vat €430.50 Global Gap Audit (GG) Contact for details Tesco Nurture Audit (TN) Contact for details Double or Triple audits (combination of above audits) Contact for details Packer Audit Contact for details Prepared Fruit and Vegetables Audit Contact for details Price includes Vat @23% Note: 1. All details furnished are confidential to Bord Bia and the Auditing Body Management Systems Certification. 2. Applications should be accompanied with a cheque for the appropriate application fee, made payable to "Bord Bia". 3. Return application forms plus application fee to this address: AgriData, Cluen, Bansha, Co Tipperary.</p><p>If you require additional documentation please contact [email protected] or ph: 01 614 2234</p>