MOWINS Check and Cartridge Re-order Form

* All Fields Required

Orders are sent to the State WIC Office at 6am on the 15th and 28th each month.
If you have questions about your order, email Peggy Maupin.

1. Agency Number/Name:

2. Number of boxes of Check Stock (3,000 checks per box): (only numeric characters accepted)

3. 9512 Printer Cartridge: (only numeric characters accepted)
(Small Printer - one cartridge will print about 15,000 checks)

4. 9612 Printer Cartridge: (only numeric characters accepted)
(Small Printer - one cartridge will print about 9,000 checks)

5. 9530 Printer Cartridge: (only numeric characters accepted)
(Large Printer - one cartridge will print about 45,000 checks)

6. Contact Name:

7. Contact Telephone:

8. Contact Email:

Missouri Department of Health & Senior Services