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application for credit
(institutional accounts only)
To Order: call toll free (800) 778-4456, Mon.-Fri. 6:00 am to 6:00 pm, and Sat. 7:00 am to 3:30 pm, PST or fax (800) 537-5403.
To Open a New Account: call toll free (866) 661-6046, Mon.-Fri. 8:30 am to 5:00 pm or fax (310) 537-0472.

Please fill in the fields below. Fields in blue are required.
school/institution:
street address:
city:
state: zip code:
e-mail:
phone number: fax number:
year established: enrollment:
sales tax exempt #: federal ID#:
(Social Security #)
owner/director:
contact person:
address:
funding/sponsoring agency (if applicable):
address:
Does your organization use purchase orders?  yes     no
bills paid by:  school     funding/sponsoring agency
bank reference: account#:
address:
city:
state: zip code:
contact person:
phone number: fax number:
List three business references below. (Please do not include personal references or utilities.)
reference 1:
name:
phone number: fax number:
account #:
reference 2:
name:
phone number: fax number:
account #:
reference 3:
name:
phone number: fax number:
account #:
By submitting this form, I hereby authorize those firms listed above to release information on my account/credit standing to Lakeshore Learning Materials. It is understood that the terms of sale at Lakeshore are net 30 days from date of invoice and that terms will be adhered to by:
name:
date: cancel   
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