Forms

WIC Vendors

Extra Vendor Stamp Order Form
Form used by WIC vendors when there is a need to order new WIC Vendor stamp(s).  When completed, the vendor returns the form and payment to the address indicated on the form. 

Vendor Order Form – WIC-5a
Form used by WIC vendors to request WIC vendor supplies.  When completed, the vendor returns the form to the state WIC office for processing.

Partial WIC Formula Redemption Form – WIC-21
Form used by WIC vendors when they do not have enough formula in their stock to meet the demands on a WIC Check. When completed by the vendor and returned to the agency by the participant, the participant can be given an additional food instrument to make up the difference of what was not available before.

Vendor Training Form – WIC-22
Form used by WIC vendors to document employee training regarding WIC transactions.

Vendor Concern Form – WIC-76
Form used by WIC vendors and returned to the state WIC office to report specific problems, concerns or suggestions that vendors may have with WIC transactions, including WIC customers, WIC checks and local WIC providers.

Approval Request For Non-Paid Checks Form – WIC-77
Form used by WIC vendors when a WIC check has been denied for payment.  When completed by the vendor, the form is sent to the state WIC office along with the WIC check and matching register receipt.