Please answer all required questions. Incomplete forms will not be considered and will not receive a response. Be sure to click the "Submit Form" button when you've completed the form. If you wish to delete all the information you've entered and start over, click the "Clear Form" button at the end of this form.

NOTE: If your retail business is not currently in operation but is scheduled to open in the near future, please do not submit a new account inquiry unless your business is scheduled to open within one to two months. Also, please be advised that Levi Strauss & Co. is not accepting inquiries regarding selling our products to third-party exporters, wholesalers or liquidators.

This form is divided into three sections:

• Contact Information
  The person who will receive a response concerning the new account inquiry.
• Company Information
  Name, address and incorporation details for the company under consideration.
• Tell Us About Your Business
  A series of questions that will give us some key information about your company.

All fields are required unless otherwise noted.

Contact Information

Company Information

Tell Us About Your Business

List all states (use two-letter abbreviations) in which you have retail locations:
(If more than one state, please separate by commas)
 

List cities and/or regions that you serve:
 

If you have more than one store location, do each of these locations carry similar merchandise and cater to the same types of consumers?
  Yes No

If 'No', please explain:
 

What is your typical store size?
(In square feet, no comma) 

Your consumer target(s) is/are primarily:
(Please check all that are appropriate)
  Men Women Youth Children  

What is the age group of your typical customer?
  13-24 25-34 35-49 50+  

What type of retail store do you operate?

If 'Specialty' or 'Other', please specify:
 

What percentage of your business would you estimate to be closeout products?
(If none, enter 0)
%

What percentage of your business would you estimate to be irregular products?
(If none, enter 0)
%

Does your company have a Web site? Yes No

If yes, please give Web site address: (Example: www.yourcompanyname.com)
   

Do you sell your merchandise on the Internet? Yes No

Please list 5-10 key brand names currently stocked by your operation in any of its channels. Focus primarily on apparel brands, but you may also include brands of shoes, accessories, perfume/cosmetics, etc.:
(Please separate brand names with commas) 

Briefly describe any unique features of your store or special services (i.e. alterations, personal shopper, concierge, etc.) that you provide to your customer:
(Optional)

Is there any additional information you would like us to know about your business?
(Optional)