Store Name
This is the store's name as it appears on the store sign or building. If you are part of a chain, provide a unique identifier for each location, such as a store number or location (e.g., Grocery Store #0259 or Grocery Store - Mahomet).
Store Street Address, Store City, Store County, Store Zip Code
This address should be a street address that can be used to locate the store's exact location.
Store Phone
This is the primary phone number at which to contact the store directly.
Store Email
This is where most communications will be sent regarding notices about the WIC program that could affect daily operations of WIC transactions and should be checked regularly.
Store Mailing Address
This must be provided if the store's mailing address differs from the street address.
Store Contact Person
Store Manager
Provide the full name and email address of the store manager.
WIC Contact Person
If the store manager is not the primary contact for WIC Business, provide the full name, role, phone number, and email address of the person who is the primary contact for WIC issues.
What type of Vendor are you applying to be authorized as?
You must select the type of vendor you wish to be authorized as. Please note that eligibility requirements for different vendor types may vary, and additional documentation may need to be provided based on the vendor type selected.
Grocer
This is a retail store that is a full-line grocery store that primarily sells food and household supplies.
Grocer with Full-Service Pharmacy
This is a full-line grocery store that sells various food and household supplies. It also has a pharmacy that operates under the same ownership and location. To operate in Illinois, the pharmacy must have a current license with the Illinois Department of Financial and Professional Regulations.
Pharmacy
This retail store primarily sells prescription drugs, over-the-counter medications, and other medical supplies. To operate as a pharmacy in Illinois, it must have a current license from the Illinois Department of Financial and Professional Regulations.
Does your store have a pharmacy available on-site under the same ownership?
If you selected a vendor type of Grocery w/ Pharmacy or Pharmacy, you must respond to this question to determine eligibility to apply as this type of vendor. If your store does not have a licensed pharmacy at the exact location as the grocery store, or if you have a pharmacy at the precise location but another company operates it, you will be required to change your response to the previous question to the vendor type Grocer to be able to submit your application.
Store Hours
Please check if the store is open 24 hours a day. If not, provide the daily opening and closing times.
SNAP Authorization Status
Select the response that best reflects your authorization status as a SNAP Vendor.
- If you have applied for authorization but have not yet been authorized, provide the SNAP Application number supplied by USDA.
- If you are authorized to accept SNAP, provide your 7-digit SNAP Authorization Number, provided to you upon authorization by USDA.
