US Retail Opportunities

If you are a business owner or manager and wish to open an account with LASHFOOD®, please fill in the form below. A customer service representative will contact you within 5 business days.

* - Required Fields


General Infomation
*	First Name:
*	Last Name:
*	Email:
*	Phone:
	Fax:
	Company:
	Title:
*	Type of Business:
	How long have you been in business?
	What trade shows, if any, do you attend?
	What similar product(s), if any, do you currently sell:

For Special Sample/Resale Pricing Eligibility
	Business License:
	Federal Tax ID:

Billing Address
	Address1:
	Address2:
	City:
	State:
	Postal Code:
	Country:	United States Only

Shipping Address (if not the same as billing)
	Address1:
	Address2:
	City:
	State:
	Postal Code:
	Country:	United States Only
	Website URL:	I have a website.

How did you hear about us?
	Magazine Newspaper Trade Show Mailer Internet Referal Other
	Comments: