Here is your signed document Balchem TLA QUE

Human Nutrition & Health | Animal Nutrition & Health | Specialty Products 5 Paragon Drive Montvale, NJ 07645 p. 845.326.5600 www.balchem.com f. 845.326.5702 Albion Albion Gold Medallion Creatine MagnaPower TRAACS Calci-K VitaCholine VitaShure K2VITAL OptiMSM Optifolin+ Ferrochel Balchem TLA Questionnaire 1. Counterparty Entity Name: *Registered or official entity name only. 2. Counterparty Registered or Principal Business Address: *Must be legal, registered address. Street: ___________________________________________________ City: State / Province / Region: ________________________________ Zip / Postal Code: Country: BBBBBBBBBBBBBBB__________________________________ Phone: ____________________________ 3. State and Country of Registration or Incorporation: *Must include both. 4. If non-US entity, please provide EU VAT, GST or other registration number: Please also attach a copy of a certificate of incorporation, certificate of good standing, or equivalent to confirm Counterparty is a registered company in the country in which it operates. 5. Counterparty Signee Name: Email Address: 6. What contract format does the customer accept? Adobe Sign Word Doc for Red-line 7. Principal Owner’s name and Country/State of Residence: * If a public company, name of CEO. _____________________________________________________________________________________________________ 8. Trademark(s) to be licensed: 9. Account Manager: ___________________________________________________________________________ 10. What is the Customer’s brand name of the product that will be using the Trademark? i.e. One A Day 11. What is the Customer’s specific product name that will utilize the Trademark? i.e. Women’s 50+ Healthy Advantage Multivitamin 12. Website URL: ________________________________________________________________________________ TLA Questionnaire | Page 1 of 2James Pollett221 E 4th STE 2300 CINCINNATI N/A Andrea Plaut OHIO, UNITED STATES X FEMSTATE™ RESET FEMSTATE™ Femstate LLC 45202 ANDREA PLAUT / UNITED STATES / OHIO UNITED STATES 5135921801 OHIO andreaplaut79@gmail.com WWW.FEMSTATE.ME X Human Nutrition & Health | Animal Nutrition & Health | Specialty Products 5 Paragon Drive Montvale, NJ 07645 p. 845.326.5600 www.balchem.com f. 845.326.5702 13. Where will the trademarks be used? i.e. Supplement Facts / Packaging / Marketing Materials 14. Ingredients being used: 15. What category does the brand participate in? Choose all applicable Food Drug & Mass General Wellness On-Line MLM Specialty Retailer Sports Nutrition Practitioner Pharmaceutical 16. Countries where product will be sold (for information only) 17. Does the customer work with a contract manufacturer? YES NO Contract manufacturer information: Name: Site Address: ________________________ Website: Phone: Name: Site Address: ________________________ Website: Phone: Name: Site Address: ________________________ Website: Phone: Name: Site Address: ________________________ Website: Phone: Name: Site Address: ________________________ Website: Phone: 18. Is the contract manufacturer purchasing raw materials on your behalf? YES NO Completed by Approved by Account Manager Director of Sales Date Date TLA Questionnaire | Page 2 of 2James PollettX Iron (as Ferrous Bisglycinate Chelate Ferrochel(R) 18mg X UNITED STATES Product Packaging / Supplement Facts / Website / Marketing Materials FOR FEMSTATE™ RESET X MAKERS NUTRITION X8/31/2026