Food Submission | Nevada WIC

Downloadable UPC Submission Forms:

Complete all sections of this form to submit a new product for review:

Include a copy of the product label showing the product name, size and ingredient list. Multiple pictures can be submitted.
Include a copy of the product UPC barcode with all 12 digits listed.
Fax or email this completed form, product pictures, and barcode to:

Fax: 775-684-4246

E-mail: DPBHWICVendor@health.nv.gov

If you have any questions, please contact the Vendor Coordinator Marisa Cook at 775-400-0624 or DPBHWICVendor@health.nv.gov.

Contact Information
We need to be able to contact you if there are questions on the product submitted.
Name*
Phone Number*
Email Address*
Product Information
Food Item Name and Type:*
Item Price*
Package Size*
Weight and/or Volume
UPC Code*
MUST INCLUDE ALL 12 DIGITS
Product Label & Nutrition Facts*
Please provide the full product label to include: front panel, nutrition fact section, and ingredients. Up to five pictures can be submitted (20MB each maximum).
Drop files here or

Accepted file types: pdf, jpg, gif, png.

Contact Information