Vendor Order Form

Downloadable Form - Vendor Order Form PDF

Shelf Tag

Door Sign

Order Options:
Store Supplies
- WIC Approved Shelf Tags - 1 Roll of 250
- “WIC Accepted Here” lane markers 5" x 3"
- “WIC Accepted Here” door sign 7.5" x 5.5"
Lane Marker - Amount Needed
Please enter a number from 1 to 100.
Door Sign - Amount Needed
Please enter a number from 1 to 100.
Store Name and Number*
Contact Name*
First Last
Email*
Mailing Address*
Address Address Line 2 City State ZIP
Comments
This field is for validation purposes and should be left unchanged.

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The WIC Program is prohibited from discriminating on the basis of race, color, national origin, sex (including gender identity and sexual orientation), disability, age or reprisal or retaliation for prior civil rights activity. | USDA Nondiscrimination Statement: (English) (Spanish)

To file a complaint of discrimination, write to: USDA, Director, Center for Civil Rights Enforcement, 1400 Independence Avenue, SW, Washington, D.C. 20250-9410.

Order Options: