Georgia WIC Program Office of Vendor Management
Vendor Application and Forms
How to Become a WIC Authorized Vendor
Vendors are an important part of the Georgia WIC Program. To become an authorized Georgia WIC vendor, you must complete an Eligibility Assessment Survey to determine if you meet the required criteria to receive an application packet.
Eligibility Assessment Survey
Eligibility Assessment Survey Link: GA WIC Vendor Portal.
Note: Vendor applicants need to provide a valid email address to receive an auto-generated email during this process that will include the eligibility results of the survey. If eligible, you will receive an application submission link, user ID, and password at the email address provided.
Apply Online
Vendor Applicants must use the GA WIC Vendor Portal to complete and submit the application and documents listed on the Required Document Checklist. Failure to accurately complete the application may result in processing delays or the denial of an application. It is recommended that vendor applicants gather the required documents and complete the vendor application materials before creating a profile on the vendor portal.
Vendor Application and Forms
Please review the information below carefully, as different requirements may apply depending on whether you are classified as non-corporate or corporate, and whether your business type is a grocer or pharmacy.
Required Documents for Non-Corporate Applicants
According to Georgia WIC policies, vendor applicants owning one store under one corporate entity are classified as non-corporate and issued a two (2) year fixed term agreement. Non-corporate applicants must complete and submit a Vendor Application with the relevant supporting documentation listed on the Required Document Checklist.
The Vendor Application and Supporting Documents below are required for the application submission along with the documents indicated on the Required Document Checklist.
Non-Corporate Grocer Applicants
Non-Corporate Pharmacy Applicants
Supporting Documents for Non-Corporate Grocer and Pharmacy Applicants
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Corporate
Information Form
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W-9 Form
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RD 1062
(2023-2025) New Applicants Only
-
RD
1062 (2025-2027) Re-Authorization Only
After completing the Vendor Application and gathering the supporting materials and documents listed on the Required Document Checklist, you can submit both the application and supporting materials using the hyperlink below to create your applicant profile.
Submit your completed Non-Corporate Vendor Application Here.
Required Documents for Corporate Applicants
According to Georgia WIC policies, vendor applicants owning two or more stores under one corporate Federal Employee Identification Number (FEIN) are classified as corporate and issued a three (3) year fixed term agreement. Corporate applicants must complete and submit a Vendor Application, one (1) Corporate Attachment Form for each store applying, one (1) Corporate Information Form, and documents listed on the Required Documents Checklist.
The Vendor Application and Supporting Documents below are required for the application submission along with the documents indicated on the Required Document Checklist.
Corporate Grocer Applicants
Corporate Pharmacy Applicants
Supporting Documents for Corporate Grocer and Pharmacy Applicants
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Required
Documents Checklist
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Corporate Information
Form
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W-9 Form
-
Grocer
Vendor Training Checklist
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Pharmacy Vendor
Training Checklist
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RD 1062
(2022-2025) New Applicants Only
-
RD
1062 (2025-2026) Re-Authorization Only
After completing the vendor application and gathering supporting materials and documents listed on the Required Document Checklist, submit both the application and supporting materials using the appropriate hyperlink below.
Existing Corporate Vendors already authorized by the Georgia WIC Program, use the vendor portal link below to submit the application materials.
Existing Corporate Vendors - Submit your application materials here (Vendor Portal link).
New Corporate Vendors that are NOT already authorized by the Georgia WIC Program must create a profile first and then use the vendor portal link below to submit the vendor application materials.
New Corporate Vendors - Submit your application materials here (Vendor Portal link).
Approved Infant Formula Suppliers
All vendor applicants and authorized vendors are required to purchase infant formula solely from suppliers selected and approved by Georgia WIC.
Page last updated 11/07/2024