Date submitted: 00/00/0000
ACCOUNT PROFILE
Company Name	Golden Caribbean Tan
Contact First Name	Jesse	Contact Last Name	Lemanski
Business Address	200 Parkbrooke Drive Ste 110	Suite/Unit	110
City	Woodstock	Province/State	GA
Zip/Postal Code	30189	Country	USA
Telephone	7705161161	Fax	7709269032
Cellular	7708263795	Email	goldencaribbeantan@att.net
Website	www.goldencaribbeantan.com
Alt. Contact	Barbara Lemanski	Alt. Telephone	7709269032
CREDIT CARD INFORMATION
Cardholder's Name	Barbara A Lemanski
Billing Address	603 Wedgewood Drive
City	Woodstock	Province/State	GA
Postal Code	30189
Card Number	5589671013277195
Expiration Date	10/15	Card Code	238
AUTHORIZATION
Authorization Name	Barbara Lemanski
Date	00/00/0000