Application Form for Category D Licensees

Please complete the Licensee Online Application to become affiliated with the Fair Labor Association (for category definitions, click here). Please make sure that you have completed all sections of the application. Incomplete applications can not be processed for approval. You will receive an automatic confirmation notice that indicates receipt of your submission.

* indicates required field

Company name: *
Contact name: *
Contact title: *
Address 1: *
Address 2:
City: *
State or Province: *
Zip / Postal code: *
Country *
Phone: *
Fax:
Email: *
Company website:

Company Total Annual Revenues*

What kind of licensed goods does your company produce?

Does your company participate in any factory compliance programs?
	Yes No
* I have read and agree with the following: I certify that our company has reviewed the eligibility criteria for membership in the Fair Labor Association as a Category D licensee. Our company has made a good faith determination that the company�s total annual revenues are less than $5 million, that its production/manufacturing facilities are in the United States, and that we are located within 200 miles of a FLA member university. Our company agrees to notify the Fair Labor Association if a change in its circumstance would cause it no longer to be eligible for Category D status. We agree to comply with the Fair Labor Association�s Workplace Code of Conduct and agrees that our company will be subject to the Fair Labor Association�s third-party complaint procedures.