Vendor Application
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Contact Name
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Company Name
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Phone Number
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Email
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Website
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Product Name(s)
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Where is product(s) manufactured or grown?
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Product Type (select one)
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Packaged Grocery
Refrigerated or Frozen
Supplements, Bodycare, Housewares, bulk herbs or teas
Bulk Foods
Beer, Wine, or other spirit
Deli Prepared Items
Baked Goods
Meat
Seafood
Produce
Dairy
Product Details (Check all that apply)
have Individual UPC/barcode
have Printed Nutrition Information
have Printed Allergen Information
Produced in Illinois
Organic
GMO-Free
Product currently sold at other retailers
Additional Product Details
Your answer
Documents and Permits (check all that apply)
Proof of Insurance ($2 million)
Food Manufacturing License
HACCP Plan
Allergen Control Program
Permit to Operate a Food Service Establishment
Food Manager’s Certification
Sales Tax Permit
Organic Certificate
Other
Any other information you'd like to include.
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Are there questions you feel would be appropriate on this application, or do you have a suggestion for making this form better?
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