New Product Request

Contact Name *:
Company Name *:
Company Address:
Company Email *:
Phone Number *:
Ext:
Fax Number:

Product Information

Please provide a brief description of the product:
Dosage Form:
If other, specify:
Active Ingredient(s):
Product Claims:
Packaging:
If other, specify:
Regulatory Classification:
If other, specify:
Distribution Channel:
If International, specify country:
Special Requirements:
Is there a similar product currently on the market? Yes No
If Yes, specify brand name:
Do any of the ingredients need to match the currently marked product?

Company Responsibility

(Choose which apply)

Formulation supplied by
Test methods supplied by
Artwork supplied by
Ingredients supplied by
Packaging supplied by
Stability supplied by
Validation supplied by

Quantities and Pricing*

Opening Order Quantity:
Annual Projections:
Target Price from MPL:
Order Requirements:
Estimated Launch Date:

* Please note: Target price is not used to determine finished product pricing. In order to establish the feasibility of this project, our software system uses an algorithm to determine if the target price can be met based on your opening projections/annual quantities, estimated cost of raw materials at the date of launch and current MPL labor and overhead rates. If your target price cannot be met the submission form will be rejected and we will notify you of this issue.

How did you
hear about MPL:
Would you like us to send you a copy of your request for your records? Yes No