Form

California WIC Eligible
Infant Fruits and Vegetables
Product Submission
Company Name*
Contact Person*
E-mail*
Street Address*
City*
State*
Zip Code*
Phone Number*
Enter product information below:

All products must meet current CA WIC Standards
UPC Code*
(12 digits and no space - bar)
Brand Name*
Product Name*
Container Size*
Package size*
Package Type*
Organic*

Yes No
I certify that this product does not contain added sugar, salt, starch or spice..*

Yes-Required
Manufacturer Suggested Retail Price*
Comments
Upload image of product label including:

front label, Nutrition Facts, legible Ingredients list and UPC
Name image using the 12 digit UPC.*
Upload a File
File types pdf, doc, xls, jpg, jpeg, gif, png, mp3, and mpeg allowed - Max upload file size is 5000 KB.
I verify that this product is distributed in California.*

check here
Should be Empty:

Infant Fruits and Vegetables