Dairy-Free Product Allergen Disclosure Form
Product Information
Product Name
Company/Brand
Contact Information
Contact Person
Email
Allergen Information
Contains Dairy
May Contain Dairy (shared equipment or facility)
Eggs
Gluten
Soy
Tree Nuts
Peanuts
Fish
Shellfish
Other (specify below)
If 'Other', please specify:
Ingredients List
Please provide the full list of ingredients:
Additional Information
Notes or Comments