DEALER REQUEST FORM
Click here to download a form to print out and fax to us at (866) 623-6151.

Name of Business:  

Business Address:  

City:         State:        Zip Code:  

Phone:  (-       Fax:  (-

Email:  

Website:  

Vendors License Number:  

Tax ID #:  

Business Type

Date Business was Established:  

Owner First Name:  

Owner Last Name:  

Home Address:  

City:        State:        Zip Code:  

Phone:  (-

Where did you see Letters from Lilly?

What percentage of your business is stationery?  %

What percentage of your business is other gift products?  %

What does a customer spend on an average stationery order?  $

Please list three trade references with telephone numbers.
1. Name:     Phone:  (-
2. Name:     Phone:  (-
3. Name:     Phone:  (-