The policy of Lestz & Company is to sell only to qualified wholesale customers. 

To qualify as a wholesale customer, please fill in the required information, print this page and mail it to: 436 - 438 W James St.; Box 4453; Lancaster, PA 17604 - or fax it to: 717 - 392 - 5416.

Company Name:  Contact Name: 
Address:   Fax #:  Phone #: 
City:   State:  Zip: 
 Tax Exempt #:   E-Mail Address: 
 
Credit Cards are Not Accepted
 
BANK REFERENCES: 
Company Name:  Contact Name: 
Address:   Fax #:  Phone #: 
City:   State:  Zip: 
 
COMMERCIAL REFERENCES: 
Company Name:  Contact Name: 
Address:   Fax #:  Phone #: 
City:   State:  Zip: 
   
Company Name:  Contact Name: 
Address:   Fax #:  Phone #: 
City:   State:  Zip: