New customers are required to complete a LEM Credit Application and fax the completed forms to Mark Holmes, Vice President, LEM
at (800) 947-7921. Requests for these forms are also taken by phone at (800) 284-2130, extension 3, or by email.

New customers may also receive these forms by completing and submitting this form.

Existing LEM customers may use this form to request an account to begin placing orders online.

Required Company Information
Bill To Name
Billing Address

Ship To Name
Shipping Address

Required User Information
Full Name
User ID
Email Address
Work Phone #
Optional Information
Alternate Email Address
Alternate Phone #
How Did You Hear About Us?
If applicable, please enter the name of the LEM Account Representative with whom you spoke.