We are excited about the opportunity of working with you! To assist us in identifying the proper services and solutions you may need, please tell us a little bit about your organization; your business; and your requirements by providing the information requested below. All information will be treated as confidential and will be used solely to assist us in designing a solution that fits your business' specific needs.

Name of your business:
Brief description of your business:
# of years in operation:
# of locations:	# Company Owned: # Independently Owned:
# of sales people:
Web address:
Primary markets you server:
Percentage of revenue by payment type:	Cash % Customer Credit Cards % Net Terms % Lease %
Whom should we contact?	Name: Title: Telephone # Email:

Of course if you are more comfortable discussing your business and program requirements via the phone, we invite you to call us at 512-344-1100 and ask to speak with one of our Program Managers.

We appreciate your interest in LGI and look forward to designing a program that meets your business requirements!