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2. Items Available for Order
4. WIC Vendor Program Booklet Quantity
5. WIC Door Decal Quantity
7. Cashier Training Manual Quantity
8. Set of Shelf Labels Quantity
10. Person Completing This Order Form
12. Name*
13. Vendor Name*
15. Address*
17. City*
18. State*
19. Zip Code*
21. Phone Number*
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23. 1. Receive an email copy of this form.
24. Email address

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25. Submit

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