NEW VENDOR
Please fill in the form below.
Name of Company or Farm
*
Contact Information
Primary Contact
*
Primary Contact Phone Number
*
Please enter a valid phone number.
Primary Email
*
Vendor Payment Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Make Check Payable To:
*
What type of product do you produce?
*
prodcuce
eggs
meat (poultry, beef, goat, etc.)
grocery product
non-food item
Is your product made, grown, or produced on a farm?
yes
no
Upload most recent DHEC inspection:
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Upload your SCDA Wholesale License:
Browse Files
Drag and drop files here
Choose a file
Cancel
of
List any other certifications or useful info:
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Submit
Should be Empty: