In House Use Only

® New Supply Account Account Number __________________

Account Type ____________________
Application Form Date Approved ______/________/_______
Approved By _____________________
Hello! Thank you for your interest in opening a Weaver Leather supply account. Please take
a few minutes to complete the following information in its entirety and return it to us via fax Toll Free in the U.S. & Canada
or mail as soon as possible. Upon receiving your application, we will assign you a Weaver Leather Phone: 800 - 932- 8371
Account Number that you may use to begin ordering from our catalog. Please note: first time orders Fax: 800 - 693 -2837
must total $250.00 or more (excluding shipping charges). If you have any questions regarding this Local & International
application, please call us at 800-932-8371 or 330-674-1782. Thank you. Phone: 330-674-1782 • Fax: 330-674-0330
7540 CR 201, PO Box 68, Mt. Hope, OH 44660-0068
(Please type or print clearly in dark ink)

Business Name ___________________________________________________________________

Renato avelino bull ropes Date _________________________
11/01/2013

Owner Name(s)_________________________________________________________________________________________________
Renato Avelino Vicentini

Federal Tax ID #_________________________________________________________________________________________________

i live in brasil

Number of Employees ________________________________

3 (Including yourself.) o Corporation o Partnership o ✔
Proprietors
Mailing Address _________________________________________________________________________________________________
fernao sales 274 barra funda

City _______________________________________________________
regente feijo . sao paulo brasil State _____________________ Zip _____________________
19570000

Shipping Address ____­_____________________________________________________________________________________________

fernao sales 274 barrafunda

City _______________________________________________________
regente feijo sao paulo brasil State _____________________ Zip _____________________
Phone (________)__________________ Fax (________)____________________ E-Mail Address_____________________________
018 97348898 renato.zum@hotmail.com

Is shipping address also your home address? o ✔

Yes o No
Attention OH, PA, TX and MI Customers: In addition to this application, we do require that you submit a Blanket Certificate of Exemption for sales tax purposes. Please contact us for a copy of this form.

Have you ever purchased from Weaver Leather before? o Yes o ✔

No If so, when? ______________________________
Under what name & address was your account listed? (If different from above.)
Name____________________________________________ Address _________________________________________________
City____________________________________ State __________ Zip __________ Phone (________)______________________

Type of Business: o
✔
Manufacturer o Repair o Retail o Other (Please explain.) _____________________
Business Hours: ___________________________________________________ Years in Business: _____________________________
12 hours 12

Type of products you may be purchasing from Weaver Leather LLC (Please check as many as are applicable.)
✔ Leather
o o Hardware o Oils/Dyes/Thread
o Nylon Webbing o Saddlery Supplies/Stirrups o Machinery/Equipment
✔ Poly Rope
o ✔ Tools
o o Harness Hardware & Parts
o Other ______________________________________________________________________________________________________
What are the primary products that you will be manufacturing? _______________________________________________________
bull ropes

What other types of items will you be manufacturing or repairing? (Please check as many as are applicable.)
o Saddles o Breast Collars o Craft Items
o Belts o Holsters/Pouches o Nylon Tack
o Harnesses o Headstalls o Gun Scabbards
o Halters o Reins o Chaps
o Bridles o Leather Pet Collars & Leashes o Saddle / Motorcycle Bags
o Boots o Nylon Pet Collars & Leashes o Clothing
o Other_______________________________________________________________________________________________________
I would like to receive leather samples from Weaver (Please check types of leather and indicate your monthly usage.)
Sides / # per mo. Sides / # per mo. Sides / # per mo. Sides / # per mo.
o Harness ________ o Strap ________ o Suede ________ o Nubuck ________
o Skirting ________ o Patent ________ o Sole Bends ________ o Deer ________
o Chrome Oil Tanned ________ o Latigo ________ o Rawhide ________ o Upholstery ________
o Shoulders ________ o Bridle ________ o Shearlings ________ o Veg Chrome Retanned _______
o Lace ________ o Other _____________________________________________________________________

o I would be interested in “odd lots” of the above leathers.

✔

o
✔
I would like to know about specials, odd lots, new products, etc.
o I have special or unusual leather requirements (Please specify.) _______________________________________________________
Please call me at (________)________________________ between the hours of ___________________ and ________________

Rev. 03/11

Please attach business card & photo of business (if available) and return to weaver Leather LLC,
Attn: Credit Dept., 7540 CR 201, PO Box 68, Mt. Hope, OH 44660-0068
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