Email this form today for an
ADDITIONAL 10% DISCOUNT
Straight off of our Everyday Low Tagged Prices

(Prior sales, Stearns & Foster and Tempur-Pedic not included)

Name
Address
City
State		(choose one) Alaska Alabama Alberta Arkansas Arizona British Columbia California Colorado Connecticut Delaware Washington DC Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Manitoba Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana Nebraska New Brunswick Newfoundland New Hampshire New Jersey New Mexico Nevada New York North Carolina North Dakota Northwest Territories Nova Scotia Ohio Oklahoma Ontario Oregon Pennsylvania Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming Yukon
Zip
Day Phone
Night Phone
E-mail Address
What Brand/or Brands do you prefer?  (check all that apply)
	Sealy		Simmons
	Stearns & Foster		Tempur-Pedic
	All of the above
Which Bedroom(s) is being considered for a new mattress set?
	Master Bedroom		Guest Room
	Childs Room		Vacation House
What Firmness do you prefer?  (check all that apply)
	Very Firm		Firm
	Medium		Soft
	Pillow Top
What size(s) are you looking for?  (check all that apply)
	Twin		Full
	Queen		King
What Price Range?
	$199-$399		$399-$599
	$599-$799		$799-$999
	$999 +
Do you need a bed frame?
	Yes		No
Do you need Delivery?
	Yes		No
When do you need your new mattress?
	Today		Tomorrow
	Day After Tomorrow		Another Day
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