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Register With Vendor Assistant

<< Return to Login Page

To apply for a user account for this website, complete ONE of the applications below:

Single Store Account  (One Store Access)

  Fill in all fields and click 'Submit Application'.

  You will receive an email invitation to return to this site and log in.

 

Email Address: 

 

(yourname@yourdomain.com, .net, or other)


Confirm Email Address: 
(must match above)

User ID
(Max 20 Characters)


User First Name:

User Last Name:

WIC Vendor ID:

Federal Tax ID#:

(Enter without dashes)

 For further assistance, please email or call the Vendor Assistant adminstrator:

Phone: 608-261-6382
Email: DHSVendorAssistant@dhs.wisconsin.gov

Corporate Owner Account  (Multi-Store Access)


  Fill in all fields and click 'Submit Application'.

  A WIC Office representative may contact you to confirm your identity and corporate affiliation.

  When your application is approved, you will receive an email invitation to return to this site and log in.


Corporate Name:


Federal Tax ID#:

(Enter without dashes)

User ID (Max 20 Characters)


Who should be contacted regarding this account?
User First Name:

User Last Name:


Area Code:

Phone Number:
(Maximum 7 digits, enter without dashes)
 

Ext.:

Email Address:
 

(yourname@yourdomain.com, .net, or other)


Confirm Email Address: 

(must match above)



  For further assistance, please email or call the Vendor Assistant adminstrator:

Phone: (608) 261-6382
Email: DHSVendorAssistant@dhs.wisconsin.gov

 

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