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2. Items Available for Order
4. WIC Approved Food List Quantity
5. WIC Door Decal Quantity
7. Set of Shelf Labels Quantity (450 labels per set)
9. Person Completing This Order Form
11. Name*
12. Vendor Name*
14. Address*
16. City*
17. State*
18. Zip Code*
20. Phone Number*
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22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit

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