Get Wic Application

Filling out the WIC application online is a straightforward process designed to assist you in becoming a vendor in the Nevada WIC Program. This guide provides step-by-step instructions to ensure that you complete the form accurately and effectively.

Follow the steps to fill out the WIC application online:

1. Press the ‘Get Form’ button to acquire the application form and open it in your chosen editor.
2. Begin by entering the store name and doing business as (dba) name in the designated fields.
3. Fill out the business location details, including city, county, state, and zip code.
4. Provide contact information including your telephone, fax number, and any other relevant contact.
5. Complete the mailing address section if it differs from the business location.
6. Indicate the legal structure of the business by checking the appropriate box, such as Corporation or Sole Proprietorship.
7. If applicable, provide the names of partners and the date and place of incorporation.
8. List the names of owners, partners, and corporate officers responsible for the store's operations, including their ownership percentage.
9. Enter bank information, such as the name of the store’s bank, branch, and account details.
10. Fill out insurance information, including the name of the liability insurance company and coverage dates.
11. Specify the training representative responsible for WIC oversight and training, including their contact information.
12. List the names and contacts for personnel involved in cashier training, operations, newsletter distribution, and vendor agreements.
13. Provide store information and classify the store type, noting if it complies with product stocking requirements.
14. Answer questions regarding previous convictions, licenses, and violations, providing necessary details.
15. Complete the general information section and ensure all required certifications and signatures are provided.
16. Review the completed application for accuracy, save your changes, then download or print the form for submission.

Complete your WIC application online today to ensure your eligibility.