* indicates a required field

SSfW™ Member ID: 0
*Company Name:
*Business Contact:
Food License#:
*Phone:  Must contain only numbers and hyphens
e.g: 000-000-0000
Alternate Phone:  Must contain only numbers and hyphens
e.g: 000-000-0000
Fax:  Must contain only numbers and hyphens
e.g: 000-000-0000
*Email:
Alternate Email:
Website:

*Address:
Address Line 2/Apt #:
*City:
*State:
*Zip:
*County:
*Company Description:
Product Descriptions:

Company Categories:
  Artisan and Craft   Association or Non-Profit Group   Bakery   Bath and Body   Beverage
  Candle   Candy and Confectionery   Cheese and Dairy   Distributor   Feed and Fertilizer
  Frozen   Fruit   Furniture and Wood   Gift and Novelty   Ginseng and Herbal
  Grocer   Honey   Jam and Jelly   Mail Order Product   Manufactured Product
  Maple Syrup   Meat   Nursery and Christmas Tree   Organic and Natural   Pet Food
  Processor   Restaurant   Retail Product   Sauce and Condiment   Seafood
  Seasoning and Spice   Services   Snack Food   Sorghum   Soup
  Specialty Retailer   Tourism   Vegetable   Wholesale Product

Company Types:
  Association   Cooperative   Direct Marketer   LLC   LTD
  Mail Order   Manufacturer   Non-Profit   Partnership   Processor
  Producer   Retailer/Store   Sole Proprietor   Virtual Store   Wholesaler

Company Logo Usage:
  Company Literature   Company Vehicle   Company Website   Other   Point of Purchase Signage
  Print Advertising   Product Label   Product Packaging   Social Media Sites   Television Advertising


Tracking Program Success

*Do you use the SSfW™ logo on your products, company literature, advertising, website, etc.?  Yes    No

If no, explain why not:



*How much has the SSfW™ program increased your sales?
0-5%     5-10%     10-20%    20%+     Other

If Other, please specify the percentage: %


*Did the sales increase require you to add jobs in your business?  If If so, how many?
Full Time:     Part Time: 

*How many jobs did you provide prior to adding jobs noted above?
Full Time:     Part Time: 

*How would you rate the overall program on a scale of 1 to 5, 5 being excellent and 1 being poor.   1    2     3    4     5



*Consider the overall program. What are we doing well? How can we improve? What services or benefits would you like to see that aren't offered today?

Product Labels
Have the member's product labels changed? If yes, send in a sample(s) for your membership file.  Yes    No
Registration Fees

*Select your Annual Sales Registration Fee
 Exempt, non-profit organization No registration fee
 Gross annual sales $0 - $10,000 $10
 Gross annual sales $10,001 - $50,000 $35
 Gross annual sales $50,001 - $100,000 $50
 Gross annual sales $100,001 - $250,000 $100
 Gross annual sales $250,001 - $500,000 $150
 Gross annual sales more than $500,000 $200

Payment
*Payment Type:
  By Credit Card Online
  By Check in the Mail
  No Fee

Application Terms and Conditions

Applicant hereby certifies that the Something Special from Wisconsin™ logo will be applied only in the fashion described above and that a minimum of 50% of the value added for the products, commodities, or services on which the logo will be used were grown, produced or processed in Wisconsin and are not an imitation.

Use of the certification mark on products, commodities or services which have received approval but undergo change in composition or labeling must be resubmitted for approval.

Applicant agrees to use the certification mark in accordance with section 93.44(2), Wis. Stats. and subchapter II, ATCP 161, Wis. Adm. Code.

Applicant further agrees not to deviate from the graphic standard provided authorized users. Only color changes may be allowed by written consent from the Wisconsin Department of Agriculture, Trade and Consumer Protection.

Membership approval does not represent that your products or their label comply with other laws including food labeling, weights and measures, and food safety laws. All applicants must submit a completed application, fee payment (credit card, check, bank order) and examples of product labels or company literature, (sample or electronically), on which the logo will be used.

Applicant will indemnify and hold harmless the State of Wisconsin Department of Agriculture, Trade and Consumer Protection and its employees from and against all product liability claims, actions, damages, costs and expenses, including reasonable attorney's fees arising out of, or in connection with, Applicant's use of the certification mark.

The right to use the certification mark herein granted shall be subject to annual permit fees under section ATCP 161, Wis. Adm. Code. Approval is only granted to applicant and may not be assigned without prior written consent of the State of Wisconsin Department of Agriculture, Trade and Consumer Protection. The term of the annual permit commences upon receipt of approval and shall continue until the annual permit expires on June 30 of each year. Termination of the agreement shall not affect any rights or remedies of the State of Wisconsin Department of Agriculture, Trade and Consumer Protection for any breach of the agreement by applicant.

Applicant acknowledges and agrees that the right to use the certification mark herein granted is non-exclusive and that the Wisconsin Department of Agriculture, Trade and Consumer Protection reserves all rights to license, assign, or otherwise use the certification mark to promote the Something Special from Wisconsin™ program, the Wisconsin Department of Agriculture, Trade and Consumer Protection, and products produced or processed in Wisconsin.

  By clicking here, I agree that I have read and understand the Something Special from Wisconsin™ membership application terms and conditions.