Charcoal Barbecue Island Grille

Company Name:	*
Name:	*
Title:	*
Business Address 1:	*
City/State/Zip:	*
PO Box (if required):
City/State/Zip:
Phone number	*
Fax Number
Email Address	*
Web site
What is your business type?	Other *
Years in Business?	*
# of storefront locations
Do you currently sell barbecues?	Yes No *
Do you currently sell Charcoal barbecues?	Yes No - Types: *
What area/region/territory do you sell to most?	*
List the top three barbecues that are currently sold by your company:	1. * 2. * N/A 3. *
Anticipated time to order	*
Comments/Questions

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By submitting this information, you are ONLY agreeing to accepting an email and phone call from a representative of Diamond Charcoal Island Grille, Inc. regarding reselling our top of line charcoal BBQ's." Expect contact within 5 business days.

This form is not a contract.

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