New Vendor Application

Application Instructions

Following these instructions is critical to submitting your new vendor application:

Vendor Application Instructions

Vendor Contract Instructions

Workers Compensation & Disability Form

 

Application Forms

NYS WIC Infant Formula Supplier List Please download and print all new vendor application material below:

WIC Vendor Application (Fillable Version )

WIC Vendor Application

NYS eWIC Readiness

Confirmation of NYS Workers’ Compensation & Disability Benefits Insurance Form

New York State WIC Applicant Pricing Declaration – Grocery

New York State WIC Applicant Pricing Declaration – Pharmacy

2 copies of the NYS WIC Program Vendor Contract

 NYS WIC Vendor Application Checklist

NYS WIC Program Bank Designation Notification

Start of Business Letter (If applicable)

Vendor Contact Information

Please note vendors must also submit the following documents as part of their application packet:

  • Copy of Food Stamp Authorization (SNAP) (Not needed for vendors applying as pharmacies)

  • Copy of Stamped NYS Certificate of Authority

  • Certificate of Incorporation OR Articles of Organization OR Business Certificate OR Partnership Certificate.

  • Signed and dated copy of the Bill of Sale OR Purchase Agreement OR written statement declaring startup of new business.

  • Deed OR signed and dated lease agreement OR Assignment of Lease.

  • Invoices or letter from approved infant formula supplier.

  • Notice of Inspection from NYSDOAM.

  • Pharmacy Registration (only needed for vendors applying as a Pharmacy or a grocery store with an embedded pharmacy)

Informational Material

Submitting your New Vendor Application

VENDOR APPLICANTS:  mail your application and all supporting materials to:

the appropriate Vendor Management Agency which has jurisdiction in your geographic area

You MUST include the following documents when mailing your WIC vendor application: (Only complete applications will be processed.)

  • A completed application for each store. (Be sure to complete all twelve pages of the application)

  • All supporting documents.

  • Completed Applicant Checklist – Processing of application will be delayed if this completed checklist is not submitted with your application package.