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)
Using Your WIC Vouchers brochure (English)
Click to view image of brochure
Using Your WIC Vouchers brochure (Spanish)
Click to view image of brochure
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 9JAQS 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.