Quote Request: Ultra Seal | UltraSeal/UltraTab

Quote Request for Contract Packaging

521 Main Street • New Paltz, NY 12561-1609 • Phone: 845.255.2490
Fax: 845.255.3553 • Email: contact us via email

Quality Review Questionnaire

This questionnaire helps UltraSeal/UltraTab evaluate your product and packaging needs. Please have your Quality Assurance personnel or Senior Officer complete this form.

* = required field
USC = Ultra Seal Corporation

* = required field

Contact Information

Company Name ^*

Contact Person ^*

USC/UTL Salesperson

Address ^*

City ^*

State ^*

Zip Code ^*

Telephone ^*

Fax

Your Email ^*

Product Information

Product Name

Manufactured By

Quantity Per Order

Estimated Annual Volume

Product Form - Other

Preservative System

Active Ingredients (one per line)

Expiration - Other

Is stability data available to support dating?
yesno

Are product samples available to USC?
yesno

Product Questions

1. How long has the product been on the market?

2. Are the raw materials that are used to manufacture your product free from BSE?
YesNoDon't Know

3. Are the materials that are used to manufacture your product free from GMO material?
YesNoDon't Know

4. List any known Allergens?
YesNoDon't Know

5. Was the finished product subjected to preservative challenge testing (USP <51> Antimicrobial Effectiveness Testing)?
YesNoDon't Know

5-n. Is Antimicrobial Effectiveness Testing required?
YesNoDon't Know

5-y. Did the data indicate that the preservative system is effective?
YesNoDon't Know

6. Should the need arise, is a copy of the data available for review?
YesNoDon't Know

7. Has your firm conducted other studies such as microbial, stability or shelf-life studies to assure the quality, strength, purity, and identity that your product purports?
YesNoDon't Know

Comments

Signed ^*

Title ^*

Date ^*

Authorization *
Accept my name, above, as my signature

Please leave this field empty.

UltraSeal/UltraTab

Ultra Seal Corporation

Quote Request for Contract Packaging

Quality Review Questionnaire

Bottles

Tubes

Packets

Blisters

Folding Carton

Shipper