New Customer Questionnaire

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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
Email: Info@lrdist.com

New Customer Questionnaire

Please complete and email to INFO@LRDIST.COM. If approved, we will contact you with the next steps.

New Customer Application

  • Max. file size: 256 MB.
    Please upload the filled out New Customer Application Form, which is available for download at the top of this page.