New Vendor Application

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

Vendor Application Instructions

Vendor Contract Instructions

Workers Compensation & Disability Form

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)

Review ALL of the following downloads before submitting a new vendor application:

WIC Vendor Overview

Section 60-1.13 – Vendor applicant enrollment criteria

NYS WIC Foods Card 

Minimum Stock Requirements -Grocery Store

Minimum Stocking Requirements – Pharmacy

Are you prepared for the On-Site Inspection?

Food Sales Information

Instructions on Counting the Number of Registers in Your Store

NYS WIC Infant Formula Supplier List