Order Form for Supplies

Resources for WIC Authorized Grocery Stores


MN WIC Program

Please provide the following information:

WIC Vendor Number:

Store Name:

Store Mailing Address - Line 1:

Address - Line 2:

City:

Zip Code:


Please indicate the quantity of each item you would like to receive:

MN WIC Shopping Guide (English) - Click to view image of Guide
MN WIC Shopping Guide (Spanish)
MN WIC Formula Insert (English and Spanish are on one) - Click to view Formula Insert
Cashier WIC Allowed Food Guide (English) - Click to view image of Cashier Guide
Cashier WIC Allowed Food Guide (Spanish)
Cashier Training DVD
Participant Training DVD
WIC Shelf Labels - Complete Set - Updated April 2014
Click to view sample Shelf Labels
WIC Shelf Labels - Blank Shelf Labels Sheet
Click to view Blank Shelf Labels sheet
Customer Incident Report Form
Cashier Checklist (English)
Poster: WIC Welcome Here (11" x 17")
Poster: WIC Welcome Here (18" x 24")
Poster: Low Fat Milk (8.5" x 11" - English) - Click to view image of Milk Poster
Poster: Low Fat Milk (8.5" x 11" - Spanish)
Poster: Low Fat Milk (8.5" x 11" - Somali)
Poster: Low Fat Milk (8.5" x 11" - Hmong)
Poster: Fresh Choices Produce (8.5" x 11" - English) - Click to view image of Produce Poster
Poster: Fresh Choices Produce (8.5" x 11" - Spanish)
Poster: Fresh Choices Produce (8.5" x 11" - Somali)
Poster: Fresh Choices Produce (8.5" x 11" - Hmong)
Poster: Fresh Choices Produce (16" x 20" - English) - Click to view image of Produce Poster
Poster: Fresh Choices Produce (16" x 20" - Spanish)
Poster: Fresh Choices Produce (16" x 20" - Somali)
Poster: Fresh Choices Produce (16" x 20" - Hmong)

 

To prevent abuse of this form, please type the following
letters/numbers DBHTU into the field below. Thank you.
(REQUIRED)

 

If you have any difficulty using this form, please contact Sarah Mallberg at sarah.mallberg@state.mn.us or 651-201-4430.