Retailer License Application

IGA Retailer Licensing Documents

Documents:

• FAQ - Sign Face Lease
• Sign Face Lease Agreement for Store Owners
• Retailer License Agreement
  

To apply to become an IGA Retailer, complete the below application.

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IGA License Application Form

Application type

Please select... Supermarket Express Change of Ownership Transfer in LDC

Open Date (approx.)

Single storeMulti-store group

Total stores

Owner Information

Prefix

Please select... Mr. Ms. Mrs.

First Name 

Last Name

Title

Email

Phone

Mobile Phone

Spouse

Prefix

Please select... Mr. Ms. Mrs.

First Name 

Last Name

Address

City

State

Zip Code

To add another owner, click the text to the right ==>>

Owning Corporation

Name of Owning Corporation

Add Owning Corporation contact information if different from store

Owning Corporation Contact Information

Phone

Email

Address

City

State

Zip Code

Store Information

Store Name

Website Address

Store Phone

Store Email

Store Address

Address

City

State

Zip Code

Add a mailing address if different from above

Mailing Address

Address

City

State

Zip Code

Add a PO Box address if separate from mailing address

PO Box Address

Address

City

State

Zip Code

   

Store Details

Store Location

FreestandingShopping Center

Selling Square Footage

Average Customer Count

Point of Sale (POS) Software

Point of Sale (POS) Version

Point of Sale (POS) Hardware

Format

Please select... Cost Plus Ethnic Fresh Foods - Organic Other Small Grocery Traditional Grocery

Store Departments and Offerings

ATM	Banking in store
Beer/Wine	Branded Food Service
Dairy	Floral
Fresh Meat	Frozen
Grocery	Hardware
Health/Beauty Care	Loyalty Program
Petroleum	Pharmacy
Photo	Produce
Ready to eat/heat meals	Seafood
Seasonal	Service Bakery
Service Deli	Spirits
Video

Payment Methods Accepted

American Express	Debit Card
Discover Card	Electronic Funds Transfer
Mastercard	Visa

Other offerings not listed above:

To add another store, click the text to the right ==>>

Marketing/Advertising your Store

Ad Group Name

Contact First Name

Contact Last Name

Email

Phone

Address

City

State

Zip Code

Advertising/Marketing Survey

Print Media

Mailed	Newspaper
Bundled	Other

Digital Media

Website	App
Coupons	SMS
Other

Social Media

Facebook	Instagram
Twitter	Other

Registered Shopper Programs

Loyalty	Fuel rewards
Other

How many members does your registered shopper program have?

Other Advertising not listed above:

Licensed Distribution Company

Name

Please select... Affiliate Program Affiliated Foods Midwest Associated Wholesale Grocers - Great Lakes Division Associated Wholesale Grocers - Oklahoma City Associated Wholesale Grocers, Gulf Coast Associated Wholesale Grocers, Inc. - KC Div. Associated Wholesale Grocers, Inc. - Nebraska Div. Associated Wholesale Grocers, Inc. Nashville Division Bozzuto's, Inc. C & S Wholesale Grocers, Inc. East Coast C & S Wholesale Grocers, Inc. West Coast Great North Foods Houchens Industries, Inc. I.G.W. LLC Ira Higdon Grocery Company Laurel Grocery Co. Merchants Distributors, LLC. Spartan Nash Spartan Nash - Lima Spartan Nash Bluefield Branch Spartan Nash Lumberton Division Spartan Nash Statesboro Branch SUPERVALU SUPERVALU - Billings SUPERVALU - Champaign SuperValu - Florida SUPERVALU - Green Bay SUPERVALU - Southeast SUPERVALU - Tacoma Unified Grocers W. Lee Flowers & Co., Inc. Other - my distributor isn't listed

If other, please indicate your distributor:

Contact First Name

Contact Last Name

Title

Phone

Email

Licensing Requirements

 

 

You will be contacted by the IGA Licensing Department to submit the following documents that are required prior to approval:

• IGA License Agreement
• IGA Sign Face Agreement
• Performance Insights Retailer Participation Agreement
• Certificate of Liability Insurance
• 2 Exterior photos and 3 Department photos

License Application Fee

Supermarket $1,800

Express $900

Change in Ownership $450

Transfer in LDC $750

 

This application was completed by:

Please select... Retailer Wholesaler/LDC IGA Area Director

 

Don't forget to click SUBMIT below!

 

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Contact Information