New Customer Application Required fields indicated with * h Company Name * Type of Business * Select One (required) Corporation Partnership Sole Proprietor Limited Liability Company Other Principle and/of Officer First Name * Last Name * Federal ID# * Company Website Physical Address Address 1 * Address 2 City * State * Zip * Country * Mailing Address (if different) Mailing Address 1 Mailing Address 2 Mailing City Mailing State Mailing Zip Mailing Country Description of Business * Type of Commodities Hauled * Is your Company Tax Exempt * Select One (required) Yes No Does your Company have a MC Number * MC Number (If your company has one) Does your Company require a purchase order * Select One (required) Yes No Does your Company require a unit number * Select One (required) Yes No Accounting Contact Name Accounting Contact Name First Name * Accounting Contact Name Last Name * Accounting Contact Phone Number * Accounting Contact Email * Name of Vehicle Insurance Company * Vehicle Insurance Company Agent * Vehicle Insurance Company Phone Number * Would you like us to run your company credit to complete the Customer set up process * Select One (required) Yes No By checking yes, you are stating “I authorize Lesco to check my credit and other information supplied on this application and/or obtain information about credit experience with me and validate my insurability.” “The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against applicants on the basis of sex or marital status. The Federal Agency which administers compliance with this law concerning Lesco, Inc. is the Federal Trade Commission, 730 Peachtree Street, NE, Atlanta, GA 30308.” Has the Business or any of its' principals filed for bankruptcy in the last past seven (7) years * Select One (required) Yes No To prove you are a human, please tell us which has four legs? Please answer question. Spider Octupus Table Please wait. Your request is processing.
