Dorothy Lane Market

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First Name:
Last Name:
Title:	If other:
Street Address:
City:
State:	OH
ZIP +4:	-
Email:
Home Phone #:	( ) -
By submitting this application, I ask that Dorothy Lane Market’s Club DLM card be issued, as I have requested, for use by me and other members of my household only. I agree to allow Dorothy Lane Market to record and make use of information about the products I purchase. I would also like to receive valuable savings and information from Dorothy Lane Market and its suppliers. I understand that Dorothy Lane Market will never share, sell, give, or tell my name and address to a third party, and DLM reserves the right to suspend, revoke, or cancel my Club DLM card at any time for any cause (Privacy Policy).
Please check this box if you do not want to receive valuable savings and special information from Dorothy Lane Market and its suppliers.