New Customer Application

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.