Get Upc Add Request Form - Nevada State Health Division - Health Nv

Filling out the UPC Add Request Form is an essential step for vendors, manufacturers, and wholesale suppliers looking to add products to the WIC approved UPC list. This guide will walk you through each section of the form to ensure a smooth and efficient submission process.

Follow the steps to successfully complete the UPC Add Request Form.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Begin by providing accurate Vendor Information. Fill in the 'Vendor Name,' 'Address,' 'Phone Number,' and 'ZIP Code' fields to identify your business.
3. Next, enter details about the Food Item. Specify the type of food item (e.g., Milk, Cheese) in the designated field. Following that, provide the specific 'Food Item Name' (e.g., Starkist Chunk Light).
4. In the 'UPC Code' field, input all the numbers exactly as they appear on the product. Ensure this information is complete to avoid delays.
5. Check the box to confirm that a copy of the UPC Code and product label have been sent. Make sure the product label contains the product name, size, and manufacturer details.
6. Complete the 'Product Information' section by circling either 'YES' or 'NO' as applicable to any questions presented.
7. Fill in the 'Date' to indicate when the form is completed. Ensure all entry points are accurate for state record-keeping.
8. Next, provide 'Item Price' and 'Authorized Signature' details as required. Make sure the person completing the form prints their name for clarity.
9. If applicable, enter the 'Store Number' and 'WIC Vendor Number' to associate your submission accurately with your business.
10. Review the entire form for accuracy. Once confirmed, save your changes, download, print, or share the form as needed for submission.

Complete the UPC Add Request Form online today to ensure your products are added to the WIC approved list.