Applications and Forms
Access most commonly used forms and applications.
Read instructions, complete, and review the checklist within each application to ensure corresponding documentation/applicable product sample is included with submission.
Effective July 1, 2019, PDAC will only accept the applications listed below.
View the Code Verification Request Application Instructions webpage for application instructions.
- Application for Code Verification Review Form
- Reconsideration Form
- Additional Verification Information Form
- Section C/Product Specific
- Manufacturer Name Change (PDF, 13 KB) - Attestation regarding Manufacturer name change resulting from a corporate merger/purchase
- Model Number Addition (PDF, 13 KB) - Attestation regarding addition of model numbers. Must print/submit on company letterhead. Submit product literature and effective begin date for new product(s)
- Private Label Agreement – Distributor Attestation (PDF, 16 KB) - Attestation Regarding Addition of New Manufacturer/Distributor Name Resulting from Private Label Agreement – Distributor Attestation
- Private Label Agreement – Manufacturer Attestation (PDF, 16 KB) - Attestation Regarding Addition of New Manufacturer/Distributor Name Resulting from Private Label Agreement – Manufacturer Attestation
- DME PDAC Contact - Submit an email to PDAC for answers to coding and product inquiries
Applications and Forms Articles
|There are no articles under this category.|