Information for Vendors Name* First Last Email* Company name*Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Website Product Names*Brief Product Description*Product Category* Grocery- Shelf Stable Grocery - Refrigerated, Dairy, or Frozen Wellness - Supplements & Body Care Beer/Cider Bulk - Dry Goods/Liquids/Herbs Meat and Seafood Cheese and Specialty Foods Bakery Produce Gifts, Housewares, and Mercantile Plants Food Service/Prepared Foods Arts & Crafts Books & Magazines (check up to 2 that apply)Additional Details* Produced within 100 miles of 4-Corners Food Coop Produced between 100-250 miles from 4-Corners Food Coop Organic Fair Trade B-Corp Other Type of Cooperative Other (Check all that apply) What other area stores or markets, if any, carry your products?*Wholesale Purchasing DetailsPlease email a one or two page Line Sheet of the items that you are looking to sell at 4-Corners Food Co-op. The name of the file should start with the business name. Please include the following information: Business contact information; General ordering information and sales terms; Product images; Product names; Product descriptions; Available flavors, scents, colors or variations; Product ingredients and sourcing (in as much detail as possible) . Wholesale prices and suggested retail price (SRP); Minimum orders or pre-pack quantities; Shipping information (estimated delivery time from PO, carrier) Email to: info@4cornersfoodcoop.comDo you currently work with distributors? If so, which ones? **Would you like to be on our Food Map?*YesNoMaybeDo you have a CSA or do you participate in a CSA?*YesNoWould you like to be a part of 4-Corners CSA?*YesNoMaybeDate Application Submitted* Date Format: MM slash DD slash YYYY
