{"id":211,"date":"2017-07-18T18:56:19","date_gmt":"2017-07-18T18:56:19","guid":{"rendered":"https:\/\/www.vdh.virginia.gov\/wic-retailers\/?page_id=211"},"modified":"2024-08-28T19:57:58","modified_gmt":"2024-08-28T19:57:58","slug":"retailer-supply-request-form","status":"publish","type":"page","link":"https:\/\/www.vdh.virginia.gov\/wic-retailers\/retailer-supply-request-form\/","title":{"rendered":"Retailer Supply Request Form"},"content":{"rendered":"<h2><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-215 alignleft\" src=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/44\/2017\/07\/ewic.png\" alt=\"\" width=\"172\" height=\"114\" \/>Virginia WIC Program<br \/>\nRetailer Supply Request Form<\/h2>\n<hr \/>\n<script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n\/* ]]> *\/\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_2' ><form method='post' enctype='multipart\/form-data'  id='gform_2'  action='\/wic-retailers\/wp-json\/wp\/v2\/pages\/211' data-formid='2' novalidate>\n                        <div class='gform-body gform_body'><ul id='gform_fields_2' class='gform_fields left_label form_sublabel_below description_below validation_below'><li id=\"field_2_31\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p style=\"font-size:17px;color:red\">Please enter the quantity for the items desired (1-99), complete the Contact Information, and select the \u201cSubmit\u201d button.<\/p>\n<hr><\/li><li id=\"field_2_39\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_39'>WIC Approved Food Brochure (FDLST-24E) \u2013 English+<\/label><div class='ginput_container ginput_container_text'><input name='input_39' id='input_2_39' type='text' value='' class='small'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_2_40\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_40'>WIC Approved Food Brochure (FDLST-24S) \u2013 Spanish+<\/label><div class='ginput_container ginput_container_text'><input name='input_40' id='input_2_40' type='text' value='' class='small'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_2_41\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_41'>Formula Flyer (FORM LST-24-ES) \u2013 English and Spanish+<\/label><div class='ginput_container ginput_container_text'><input name='input_41' id='input_2_41' type='text' value='' class='small'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_2_42\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_42'>eWIC Accepted Here \u2013Door decal*<\/label><div class='ginput_container ginput_container_text'><input name='input_42' id='input_2_42' type='text' value='' class='small'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_2_43\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_43'>eWIC Cashier Handbook  (VEN-125)+<\/label><div class='ginput_container ginput_container_text'><input name='input_43' id='input_2_43' type='text' value='' class='small'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_2_44\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_44'>Wholesome Informed Choices Shelf Labels (Option #3, 100 @ 1\u00bd\u201d x 2\u00bd\u201d )<\/label><div class='ginput_container ginput_container_text'><input name='input_44' id='input_2_44' type='text' value='' class='small'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_2_46\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_46'>Wholesome Informed Choices Shelf Labels (Option #4, 100 @ 1\u00bc \u201d x 1\u00bd \u201d)<\/label><div class='ginput_container ginput_container_text'><input name='input_46' id='input_2_46' type='text' value='' class='small'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_2_45\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_45'>Retailer Incident\/Complaint Form (WIC #387)+<\/label><div class='ginput_container ginput_container_text'><input name='input_45' id='input_2_45' type='text' value='' class='small'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_2_47\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_47'>UPC Update Request Form<\/label><div class='ginput_container ginput_container_text'><input name='input_47' id='input_2_47' type='text' value='' class='small'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_2_48\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_48'>2022 WIC Program Retailer Manual\/Guidelines (VEN-002)<\/label><div class='ginput_container ginput_container_text'><input name='input_48' id='input_2_48' type='text' value='' class='small'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_2_49\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_49'>2017 Cashier Training DVD  format w\/training aid<\/label><div class='ginput_container ginput_container_text'><input name='input_49' id='input_2_49' type='text' value='' class='small'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_2_50\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_50'>2017 Cashier Training USB format w\/training aid.<\/label><div class='ginput_container ginput_container_text'><input name='input_50' id='input_2_50' type='text' value='' class='small'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_2_51\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_51'>1-877-TELL-WIC tear-off pad (WIC-54E\/S)<\/label><div class='ginput_container ginput_container_text'><input name='input_51' id='input_2_51' type='text' value='' class='small'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_2_24\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_24'>Comment<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_24' id='input_2_24' class='textarea medium'   maxlength='100'   aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_2_25\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\"><\/h2><\/li><li id=\"field_2_34\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Contact Information<\/h2><\/li><li id=\"field_2_16\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_16'>Ship to Attention of<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_16' id='input_2_16' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_2_20\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-no-icon field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_20'>Order Date<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_20' id='input_2_20' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='04\/04\/2026' aria-describedby=\"input_2_20_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_2_20_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_2_20' class='gform_hidden' value='https:\/\/www.vdh.virginia.gov\/content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_2_17\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_17'>Store Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_17' id='input_2_17' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_2_32\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_32'>WIC ID<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_32' id='input_2_32' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_2_35\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_35'>Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_35' id='input_2_35' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_2_36\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_36'>City<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_36' id='input_2_36' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_2_37\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_37'>State<\/label><div class='ginput_container ginput_container_text'><input name='input_37' id='input_2_37' type='text' value='Virginia' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_2_38\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_38'>Zip Code<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_38' id='input_2_38' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_2_33\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_33'>Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_33' id='input_2_33' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_2_19\" class=\"gfield gfield--type-email gfield--input-type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_19'>Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_19' id='input_2_19' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_2_29\" class=\"gfield gfield--type-email gfield--input-type-email field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_29'>Alternate Email<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_29' id='input_2_29' type='email' value='' class='medium'     aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_2_52\" class=\"gfield gfield--type-captcha gfield--input-type-captcha gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_52'>CAPTCHA<\/label><div id='input_2_52' class='ginput_container ginput_recaptcha' data-sitekey='6Lc8nmYUAAAAANY0fD8OEQqIfRpo8BtCxDj3PPA0'  data-theme='light' data-tabindex='0'  data-badge=''><\/div><\/li><\/ul><\/div>\n        <div class='gform-footer gform_footer left_label'> <input type='submit' id='gform_submit_button_2' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Submit'  \/> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_2' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_2' id='gform_theme_2' value='legacy' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_2' id='gform_style_settings_2' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_2' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='2' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='USD' value='TfDnVMRvnGpJ1vDkv2ZcrxcE0qkzuTmBCFQaF8WeFQSQLsDxHo+uxC3mmU+MycXKstgjhQIQKJJWS0xums8Rnmj25Xokxt4sCOMPd3agFDfPzEw=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_2' value='WyJbXSIsImZkODQzZjIzM2EyNGQ0MzUzYjc2YzI3MzQ3OWI4OWM2Il0=' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_2' id='gform_target_page_number_2' value='0' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_source_page_number_2' id='gform_source_page_number_2' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <\/form>\n                        <\/div><script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\n gform.initializeOnLoaded( function() {gformInitSpinner( 2, 'https:\/\/www.vdh.virginia.gov\/content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery('#gform_ajax_frame_2').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_2');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_2').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;var mt = parseInt(jQuery('html').css('margin-top'), 10) + parseInt(jQuery('body').css('margin-top'), 10) + 100;if(is_form){jQuery('#gform_wrapper_2').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_2').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_2').removeClass('gform_validation_error');}setTimeout( function() { \/* delay the scroll by 50 milliseconds to fix a bug in chrome *\/  }, 50 );if(window['gformInitDatepicker']) {gformInitDatepicker();}if(window['gformInitPriceFields']) {gformInitPriceFields();}var current_page = jQuery('#gform_source_page_number_2').val();gformInitSpinner( 2, 'https:\/\/www.vdh.virginia.gov\/content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery(document).trigger('gform_page_loaded', [2, current_page]);window['gf_submitting_2'] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find('.GF_AJAX_POSTBACK').html();if(!confirmation_content){confirmation_content = contents;}jQuery('#gform_wrapper_2').replaceWith(confirmation_content);jQuery(document).trigger('gform_confirmation_loaded', [2]);window['gf_submitting_2'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_2').text());}else{jQuery('#gform_2').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger(\"gform_pre_post_render\", [{ formId: \"2\", currentPage: \"current_page\", abort: function() { this.preventDefault(); } }]);        if (event && event.defaultPrevented) {                return;        }        const gformWrapperDiv = document.getElementById( \"gform_wrapper_2\" );        if ( gformWrapperDiv ) {            const visibilitySpan = document.createElement( \"span\" );            visibilitySpan.id = \"gform_visibility_test_2\";            gformWrapperDiv.insertAdjacentElement( \"afterend\", visibilitySpan );        }        const visibilityTestDiv = document.getElementById( \"gform_visibility_test_2\" );        let postRenderFired = false;        function triggerPostRender() {            if ( postRenderFired ) {                return;            }            postRenderFired = true;            gform.core.triggerPostRenderEvents( 2, current_page );            if ( visibilityTestDiv ) {                visibilityTestDiv.parentNode.removeChild( visibilityTestDiv );            }        }        function debounce( func, wait, immediate ) {            var timeout;            return function() {                var context = this, args = arguments;                var later = function() {                    timeout = null;                    if ( !immediate ) func.apply( context, args );                };                var callNow = immediate && !timeout;                clearTimeout( timeout );                timeout = setTimeout( later, wait );                if ( callNow ) func.apply( context, args );            };        }        const debouncedTriggerPostRender = debounce( function() {            triggerPostRender();        }, 200 );        if ( visibilityTestDiv && visibilityTestDiv.offsetParent === null ) {            const observer = new MutationObserver( ( mutations ) => {                mutations.forEach( ( mutation ) => {                    if ( mutation.type === 'attributes' && visibilityTestDiv.offsetParent !== null ) {                        debouncedTriggerPostRender();                        observer.disconnect();                    }                });            });            observer.observe( document.body, {                attributes: true,                childList: false,                subtree: true,                attributeFilter: [ 'style', 'class' ],            });        } else {            triggerPostRender();        }    } );} ); \n\/* ]]> *\/\n<\/script>\n\n<hr \/>\n<h3>+Downloads are available online at:<\/h3>\n<h3><a href=\"https:\/\/www.vdh.virginia.gov\/wic-retailers\/resources\">https:\/\/www.vdh.virginia.gov\/wic-retailers\/resources<\/a><\/h3>\n<h3><strong>Contact your assigned Vendor Liaison if this order is not received within two weeks.<\/strong><\/h3>\n<p>*Additional supplies e.g. Door decals, lane signage, etc. can be ordered directly through the eWIC Processor.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Virginia WIC Program Retailer Supply Request Form +Downloads are available online at: https:\/\/www.vdh.virginia.gov\/wic-retailers\/resources Contact your assigned Vendor Liaison if this order is not received within two weeks. *Additional supplies e.g. Door decals, lane signage, etc. can be ordered directly through the eWIC Processor.<\/p>\n","protected":false},"author":54,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_lmt_disableupdate":"no","_lmt_disable":"","footnotes":""},"tags":[],"class_list":["post-211","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Retailer Supply Request Form - WIC Retailers<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.vdh.virginia.gov\/wic-retailers\/retailer-supply-request-form\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Retailer Supply Request Form - WIC Retailers\" \/>\n<meta property=\"og:description\" content=\"Virginia WIC Program Retailer Supply Request Form +Downloads are available online at: https:\/\/www.vdh.virginia.gov\/wic-retailers\/resources Contact your assigned Vendor Liaison if this order is not received within two weeks. *Additional supplies e.g. Door decals, lane signage, etc. can be ordered directly through the eWIC Processor.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.vdh.virginia.gov\/wic-retailers\/retailer-supply-request-form\/\" \/>\n<meta property=\"og:site_name\" content=\"WIC Retailers\" \/>\n<meta property=\"article:modified_time\" content=\"2024-08-28T19:57:58+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/44\/2017\/07\/ewic.png\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"1 minute\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/www.vdh.virginia.gov\\\/wic-retailers\\\/retailer-supply-request-form\\\/\",\"url\":\"https:\\\/\\\/www.vdh.virginia.gov\\\/wic-retailers\\\/retailer-supply-request-form\\\/\",\"name\":\"Retailer Supply Request Form - WIC Retailers\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/www.vdh.virginia.gov\\\/wic-retailers\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/www.vdh.virginia.gov\\\/wic-retailers\\\/retailer-supply-request-form\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/www.vdh.virginia.gov\\\/wic-retailers\\\/retailer-supply-request-form\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/www.vdh.virginia.gov\\\/content\\\/uploads\\\/sites\\\/44\\\/2017\\\/07\\\/ewic.png\",\"datePublished\":\"2017-07-18T18:56:19+00:00\",\"dateModified\":\"2024-08-28T19:57:58+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/www.vdh.virginia.gov\\\/wic-retailers\\\/retailer-supply-request-form\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/www.vdh.virginia.gov\\\/wic-retailers\\\/retailer-supply-request-form\\\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/www.vdh.virginia.gov\\\/wic-retailers\\\/retailer-supply-request-form\\\/#primaryimage\",\"url\":\"https:\\\/\\\/www.vdh.virginia.gov\\\/content\\\/uploads\\\/sites\\\/44\\\/2017\\\/07\\\/ewic.png\",\"contentUrl\":\"https:\\\/\\\/www.vdh.virginia.gov\\\/content\\\/uploads\\\/sites\\\/44\\\/2017\\\/07\\\/ewic.png\"},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/www.vdh.virginia.gov\\\/wic-retailers\\\/retailer-supply-request-form\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/www.vdh.virginia.gov\\\/wic-retailers\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Retailer Supply Request Form\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/www.vdh.virginia.gov\\\/wic-retailers\\\/#website\",\"url\":\"https:\\\/\\\/www.vdh.virginia.gov\\\/wic-retailers\\\/\",\"name\":\"WIC Retailers\",\"description\":\"\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/www.vdh.virginia.gov\\\/wic-retailers\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Retailer Supply Request Form - WIC Retailers","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/www.vdh.virginia.gov\/wic-retailers\/retailer-supply-request-form\/","og_locale":"en_US","og_type":"article","og_title":"Retailer Supply Request Form - WIC Retailers","og_description":"Virginia WIC Program Retailer Supply Request Form +Downloads are available online at: https:\/\/www.vdh.virginia.gov\/wic-retailers\/resources Contact your assigned Vendor Liaison if this order is not received within two weeks. *Additional supplies e.g. Door decals, lane signage, etc. can be ordered directly through the eWIC Processor.","og_url":"https:\/\/www.vdh.virginia.gov\/wic-retailers\/retailer-supply-request-form\/","og_site_name":"WIC Retailers","article_modified_time":"2024-08-28T19:57:58+00:00","og_image":[{"url":"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/44\/2017\/07\/ewic.png","type":"","width":"","height":""}],"twitter_card":"summary_large_image","twitter_misc":{"Est. reading time":"1 minute"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/www.vdh.virginia.gov\/wic-retailers\/retailer-supply-request-form\/","url":"https:\/\/www.vdh.virginia.gov\/wic-retailers\/retailer-supply-request-form\/","name":"Retailer Supply Request Form - WIC Retailers","isPartOf":{"@id":"https:\/\/www.vdh.virginia.gov\/wic-retailers\/#website"},"primaryImageOfPage":{"@id":"https:\/\/www.vdh.virginia.gov\/wic-retailers\/retailer-supply-request-form\/#primaryimage"},"image":{"@id":"https:\/\/www.vdh.virginia.gov\/wic-retailers\/retailer-supply-request-form\/#primaryimage"},"thumbnailUrl":"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/44\/2017\/07\/ewic.png","datePublished":"2017-07-18T18:56:19+00:00","dateModified":"2024-08-28T19:57:58+00:00","breadcrumb":{"@id":"https:\/\/www.vdh.virginia.gov\/wic-retailers\/retailer-supply-request-form\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/www.vdh.virginia.gov\/wic-retailers\/retailer-supply-request-form\/"]}]},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/www.vdh.virginia.gov\/wic-retailers\/retailer-supply-request-form\/#primaryimage","url":"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/44\/2017\/07\/ewic.png","contentUrl":"https:\/\/www.vdh.virginia.gov\/content\/uploads\/sites\/44\/2017\/07\/ewic.png"},{"@type":"BreadcrumbList","@id":"https:\/\/www.vdh.virginia.gov\/wic-retailers\/retailer-supply-request-form\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/www.vdh.virginia.gov\/wic-retailers\/"},{"@type":"ListItem","position":2,"name":"Retailer Supply Request Form"}]},{"@type":"WebSite","@id":"https:\/\/www.vdh.virginia.gov\/wic-retailers\/#website","url":"https:\/\/www.vdh.virginia.gov\/wic-retailers\/","name":"WIC Retailers","description":"","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/www.vdh.virginia.gov\/wic-retailers\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"}]}},"_links":{"self":[{"href":"https:\/\/www.vdh.virginia.gov\/wic-retailers\/wp-json\/wp\/v2\/pages\/211","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.vdh.virginia.gov\/wic-retailers\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.vdh.virginia.gov\/wic-retailers\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.vdh.virginia.gov\/wic-retailers\/wp-json\/wp\/v2\/users\/54"}],"replies":[{"embeddable":true,"href":"https:\/\/www.vdh.virginia.gov\/wic-retailers\/wp-json\/wp\/v2\/comments?post=211"}],"version-history":[{"count":21,"href":"https:\/\/www.vdh.virginia.gov\/wic-retailers\/wp-json\/wp\/v2\/pages\/211\/revisions"}],"predecessor-version":[{"id":1844,"href":"https:\/\/www.vdh.virginia.gov\/wic-retailers\/wp-json\/wp\/v2\/pages\/211\/revisions\/1844"}],"wp:attachment":[{"href":"https:\/\/www.vdh.virginia.gov\/wic-retailers\/wp-json\/wp\/v2\/media?parent=211"}],"wp:term":[{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.vdh.virginia.gov\/wic-retailers\/wp-json\/wp\/v2\/tags?post=211"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}