:::OMAHA GRILLS:::

REGISTRATION

Thank you for purchasing an Omaha GrillsTM Grill. Please complete the registration
form below and submit. Note that you can find the model and serial numbers on
the placard placed on the back of your grill.

1. First Name: Last Name:

2. Address: (number and street) Apt:

City State (State/Province)

Zip Code Country

3. Phone Number Daytime:

4. Email Address:

5. Date of Purchase: Day Month Year

6. Purchase Price $ 7. Name of Store:

8. What Model Did You Purchase?

9. Serial Number: -