American Tanning & Leather Co.

Tanners of Fine Alligator and Exotic Leather

730 Pimento Avenue, Building A, Griffin, Georgia  USA  30224

Phone:  (770) 228-4433  Fax:  (770) 228-8229

E-Mail: sales@amtan.com  Web Site:  http://www.amtan.com/

CUSTOMER INFORMATION SHEET:

Company Name (if applicable):________________________________________________________  

 Customer Last Name:____________________   Customer First Name:_______________________

 Billing Address:____________________________________________________________________

 City:__________________________   State:_______________   Zip:___________________

 Shipping Address:___________________________________________________________________

 City:__________________________   State:_______________   Zip:___________________

 Daytime Phone:_________________________   Evening Phone:_____________________________

 Cell Phone:____________________________   Fax Number:_______________________________

 E-mail Address:____________________________________

BILLING INFORMATION

Deposit Amount:____________

 Paid by:    

 Credit Card Number:_______________________________ Exp:________________________

Billing Zip Code:_______ 3 or 4 Digit SEC Code (back of VISA/MC, Front of AMEX):______

 Name as Appears on Card:______________________________________________________

 If paying by credit card, I hereby authorize American Tanning and Leather to charge my card for the deposit amount listed above.  Additionally, I authorize American Tanning and Leather Company to charge my card for the balance remaining when my skins are complete.  I understand that my skins will be shipped to me on the same day the final balance is charged. 

 Signature:______________________________________________________________________________

 (If deposit is received in the form of a check or cashier’s check/money order, I understand that American Tanning and Leather will bill me for the final balance due, and I will be responsible for arranging payment before my skins are shipped to me.)

TANNING INSTRUCTIONS

 Please fill out information completely for each skin shipped.  Staple this sheet to the completed customer sheet.  If both sheets are not received, we CANNOT process your skin.   Please make copies of this page for additional skins.

 Skin Type (Check One):       

 Tag Information-  State:____________  Number:____________________________

 Approximate Length (in Feet):___________________________________________

 Desired Color (Check One):  CLASSIC COLORS:      

DESERT COLORS:   

Skin Type (Check One):       

Tag Information-  State:____________  Number:____________________________

Approximate Length (in Feet):___________________________________________

Desired Color (Check One):  CLASSIC COLORS:      

DESERT COLORS: