Beds By George

Quote Request for Dream Series

This is not an order.  It is the first step to placing an order, but we will not proceed without your explicit approval.  

Please fill out this form completely.  Know that any of the choices you select today can be changed, but we need this information to provide you the best possible price. When this form is completed, we will contact you with your price.  We do not distribute nor sell your contact information to anyone.

Headboard Styles
Models
Post Options
Beds By George DREAM SERIES
Quote Request.

All fields with * are required

*Mattress Size *
*Safety Sides *
*Door Style *
*Sleep Surface Function *
*Transfer Height from floor *
*Headboard Style *
If canopy is desired, select straight headboard
*Corner Post Style *
*Wood *
*Stain *
Accent Carving Head/Foot
Accent Carving Doors
Engraving (enter text)
text should be spelled and punctuated exactly as you wish it to appear on the headboard.
*Feet *
Accessory
 IV pole 
 Interior Padding 
 Drawers (na for electric) 
 Window in headboard 
 Window in footboard 
 Access port in headboard (for tubes) 
 Access port in footboard (for tubes) 
Mesh Canopy Topper
*I am a *
 Parent 
 Caregiver 
 Therapist 
 Medical Personnel 
 Advocate 
 DME 
 Other 
Contact Name *

First

Last
Quote Reference
Company Name
Shipping Address *
Address 2
City, State, Zip Code *
Do you have a forklift or dock? *
Phone Number *

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*Contact e-mail *
Quotes are emailed to this address
Plan to submit to insurance *
Private insurance, Medicaid, Waiver, etc.
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