Maine WIC waxay rabtaa inaad yeelato khibrad wax ku iibsan oo wanaagsan. Waan ku qanacsanahay inaad nala wadaagto arrimahaaga.

Ku saabsan:

Magaca *

Email *

Telefoonka

Zip Code

Lambarka Kaarka (4 lambar ee ugu dambeeyay) *

Store or Farmer Name (or NA if not applicable)*

Lambarka dukaanka ama goobta (ama NA haddii aysan khusayn) *

Taariikhda la soo saaray (loo baahan yahay **)

Waqtiga la bixinayo

Ku Saabsan Khibradaada

Arrin PIN ahKhibrad ganacsi oo weynAnigu kuma iibsan karo wax soo saar gaar ah WIC (ku dheji sawirada alaabada iyo rasiidhada)Anigu waxba kuma iibsan karo WIC (ku dheji sawirada alaabada, rasiidhada, PIN pad haddii ay khuseyso)Arrin lacag-yareKhibrad kale ama fikrad lagu hagaajiyo

Sharaxaadda arrinta ama fikradda:

SAWIRRO (Badeecad, risiidhada, farriinta suufka PIN, iwm)

Fadlan sawirro ka qaad waxyaabaha aad iibsan kari weyday, rasiidhada, ama farriimaha sirta ah ee loo yaqaan 'PIN pad' (haddii ay khuseyso), ka dib halkan ku dar adigoo riixaya badhanka 'Dooro Faylka'. Fadlan hal sawir kaliya ku soo dhig 'Dooro Faylka' badhanka.

Fadlan ka dhaaf meeshaan banaan.