Consumer Interest Form

Thank you for your interest in having the Diamon-Fusion® technology applied to a surface in your home or business. Please complete the form below in as much detail as possible and we will contact you shortly.

WORLDWIDE CORPORATE OFFICES - USA
DFI - Diamon Fusion International, Inc.
9361 Irvine Boulevard
Irvine, California 92618
USA

1-800 213-0793 Toll free in USA
+ 1 949 388-8000 Telephone Main Office
+ 1 949 388-3299 Fax Main Office

Reach us at:
info@diamonfusion.com

You may also use this form to contact us:
Fields marked with a * are required.

Name:*  
Company:*
  
Address:
  
*Address Line 1

Address Line 2 (optional)
Country:*
State/Province:*
City:*
Zip Code:*
Telephone:*  
Fax:
Email:*
Website:
Describe the area you’d like to have treated with Diamon-Fusion®:
How soon would you like this to be completed?:
How did you hear about us?:*

Internet Search
Trade Magazines/ News Article (Please Specify Name)
Friend/Business Associate
DFI Licensee (Please Specify Company Name)
DFI Representative (Please Specify Rep. Name and Country)
Business Journal / Newspaper / Nanotechnology related (Please Specify Name)

Please Specify: