{"id":836,"date":"2019-05-10T14:14:54","date_gmt":"2019-05-10T14:14:54","guid":{"rendered":"https:\/\/www.vdh.virginia.gov\/wic-retailers\/?page_id=836"},"modified":"2019-05-10T14:16:50","modified_gmt":"2019-05-10T14:16:50","slug":"application-contact","status":"publish","type":"page","link":"https:\/\/www.vdh.virginia.gov\/wic-retailers\/application-contact\/","title":{"rendered":"Application Contact"},"content":{"rendered":"<p>&nbsp;<\/p>\n<script>\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<\/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_16' >\n                        <div class='gform_heading'>\n                            <h3 class=\"gform_title\">Virginia WIC Food Application Contact Form<\/h3>\n                            <p class='gform_description'>Retailers, Manufacturers, and Distributors Contact Information<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_16'  action='\/wic-retailers\/wp-json\/wp\/v2\/pages\/836' data-formid='16' novalidate>\n                        <div class='gform-body gform_body'><ul id='gform_fields_16' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_16_2\" class=\"gfield gfield--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_16_2'><span class='gform-field-label__text'>Company Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_2' id='input_16_2' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_16_3\" class=\"gfield gfield--type-name 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 gfield_label_before_complex' ><span class='gform-field-label__text'>Contact Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_16_3'>\n                            \n                            <span id='input_16_3_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_3.3' id='input_16_3_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_16_3_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_16_3_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_3.6' id='input_16_3_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_16_3_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_16_4\" class=\"gfield gfield--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_16_4'><span class='gform-field-label__text'>Job Title<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_4' id='input_16_4' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_16_5\" class=\"gfield gfield--type-address 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 gfield_label_before_complex' ><span class='gform-field-label__text'>Mailing Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_16_5' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_16_5_1_container' >\n                                        <input type='text' name='input_5.1' id='input_16_5_1' value=''    aria-required='true'    \/>\n                                        <label for='input_16_5_1' id='input_16_5_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_16_5_2_container' >\n                                        <input type='text' name='input_5.2' id='input_16_5_2' value=''     aria-required='false'   \/>\n                                        <label for='input_16_5_2' id='input_16_5_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_16_5_3_container' >\n                                    <input type='text' name='input_5.3' id='input_16_5_3' value=''    aria-required='true'    \/>\n                                    <label for='input_16_5_3' id='input_16_5_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_16_5_4_container' >\n                                        <input type='text' name='input_5.4' id='input_16_5_4' value=''      aria-required='true'    \/>\n                                        <label for='input_16_5_4' id='input_16_5_4_label' class='gform-field-label gform-field-label--type-sub '>State \/ Province \/ Region<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_16_5_5_container' >\n                                    <input type='text' name='input_5.5' id='input_16_5_5' value=''    aria-required='true'    \/>\n                                    <label for='input_16_5_5' id='input_16_5_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_5.6' id='input_16_5_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_16_6\" class=\"gfield gfield--type-phone gfield--phone-format-standard 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_16_6'><span class='gform-field-label__text'>Phone<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_6' id='input_16_6' type='tel' value='' class='medium'  placeholder='(999) 999-9999' aria-required=\"true\" aria-invalid=\"false\"   data-mask=\"(999) 999-9999\" \/><\/div><\/li><li id=\"field_16_7\" class=\"gfield gfield--type-phone gfield--phone-format-standard 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_16_7'><span class='gform-field-label__text'>Fax<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_7' id='input_16_7' type='tel' value='' class='medium'  placeholder='(999) 999-9999' aria-required=\"true\" aria-invalid=\"false\"   data-mask=\"(999) 999-9999\" \/><\/div><\/li><li id=\"field_16_8\" class=\"gfield gfield--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_16_8'><span class='gform-field-label__text'>Email<\/span><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_8' id='input_16_8' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_16_9\" class=\"gfield gfield--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_16_9'><span class='gform-field-label__text'>Product Brand(s)<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_9' id='input_16_9' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><\/ul><\/div>\n        <div class='gform-footer gform_footer top_label'> <button type='submit' id='gform_submit_button_16' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' >Submit<\/button> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_16' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_16' id='gform_theme_16' value='legacy' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_16' id='gform_style_settings_16' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_16' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='16' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='USD' value='UIl31zobnWp\/5I+eg3mk8\/7K1K1goIiniYxT\/aLliDq9n0njU5re+Nv+jsEupG3vumicXX67\/1akFniK\/pPUYd2wrx5IO68hsrFQnE9hCK+OOKs=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_16' value='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' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_16' id='gform_target_page_number_16' value='0' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_source_page_number_16' id='gform_source_page_number_16' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <\/form>\n                        <\/div>\n","protected":false},"excerpt":{"rendered":"<p>&nbsp;<\/p>\n","protected":false},"author":200,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"tags":[],"class_list":["post-836","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.2 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Application Contact - 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\/application-contact\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Application Contact - WIC Retailers\" \/>\n<meta property=\"og:description\" content=\"&nbsp;\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.vdh.virginia.gov\/wic-retailers\/application-contact\/\" \/>\n<meta property=\"og:site_name\" content=\"WIC Retailers\" \/>\n<meta property=\"article:modified_time\" content=\"2019-05-10T14:16:50+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\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\\\/application-contact\\\/\",\"url\":\"https:\\\/\\\/www.vdh.virginia.gov\\\/wic-retailers\\\/application-contact\\\/\",\"name\":\"Application Contact - WIC Retailers\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/www.vdh.virginia.gov\\\/wic-retailers\\\/#website\"},\"datePublished\":\"2019-05-10T14:14:54+00:00\",\"dateModified\":\"2019-05-10T14:16:50+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/www.vdh.virginia.gov\\\/wic-retailers\\\/application-contact\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/www.vdh.virginia.gov\\\/wic-retailers\\\/application-contact\\\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/www.vdh.virginia.gov\\\/wic-retailers\\\/application-contact\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/www.vdh.virginia.gov\\\/wic-retailers\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Application Contact\"}]},{\"@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":"Application Contact - 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\/application-contact\/","og_locale":"en_US","og_type":"article","og_title":"Application Contact - WIC Retailers","og_description":"&nbsp;","og_url":"https:\/\/www.vdh.virginia.gov\/wic-retailers\/application-contact\/","og_site_name":"WIC Retailers","article_modified_time":"2019-05-10T14:16:50+00:00","twitter_card":"summary_large_image","schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/www.vdh.virginia.gov\/wic-retailers\/application-contact\/","url":"https:\/\/www.vdh.virginia.gov\/wic-retailers\/application-contact\/","name":"Application Contact - WIC Retailers","isPartOf":{"@id":"https:\/\/www.vdh.virginia.gov\/wic-retailers\/#website"},"datePublished":"2019-05-10T14:14:54+00:00","dateModified":"2019-05-10T14:16:50+00:00","breadcrumb":{"@id":"https:\/\/www.vdh.virginia.gov\/wic-retailers\/application-contact\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/www.vdh.virginia.gov\/wic-retailers\/application-contact\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/www.vdh.virginia.gov\/wic-retailers\/application-contact\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/www.vdh.virginia.gov\/wic-retailers\/"},{"@type":"ListItem","position":2,"name":"Application Contact"}]},{"@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\/836","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\/200"}],"replies":[{"embeddable":true,"href":"https:\/\/www.vdh.virginia.gov\/wic-retailers\/wp-json\/wp\/v2\/comments?post=836"}],"version-history":[{"count":5,"href":"https:\/\/www.vdh.virginia.gov\/wic-retailers\/wp-json\/wp\/v2\/pages\/836\/revisions"}],"predecessor-version":[{"id":841,"href":"https:\/\/www.vdh.virginia.gov\/wic-retailers\/wp-json\/wp\/v2\/pages\/836\/revisions\/841"}],"wp:attachment":[{"href":"https:\/\/www.vdh.virginia.gov\/wic-retailers\/wp-json\/wp\/v2\/media?parent=836"}],"wp:term":[{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.vdh.virginia.gov\/wic-retailers\/wp-json\/wp\/v2\/tags?post=836"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}