2013/2014 WIC VENDOR AGREEMENTWic Vendor Agreement • December 12th, 2013
Contract Type FiledDecember 12th, 2013FORM: WVA-1 OWNERSHIP INFORMATION (Please Print) Ownership Type: Sole Proprietorship Partnership Limited Liability Company (LLC) Franchise Corporation Ownership Name: Address: City/State/ZIP: Store Name & Address: (If more than one store, fill out form MS-1) WIC Vendor Stamp Number (if currently authorized): Bank Name: Routing Number: Account Number: