New Customer Application


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Corporate Office:
88 35th Street
Building 4, 5th floor Suite D
Brooklyn, NY 11232

Phone: (718)272-2100
Outside of Area: (800)441-7173
Fax: (718)272-2110
www.lrdist.com


New Customer Application

Please be advised that you can type directly into the fields on each page of the customer application and then print it to PDF or print it out and attach it back to this web page if you don’t want to fill it out by hand.


New Customer Application

  • Please upload the filled out New Customer Application Form, which is available for download at the top of this page.