Custom Bed Order Form

Select today's date:

Personal Information

Last name:

First name:

Address:

City:

State:

Zip:

Home phone:

Other phone:

Email:

Order Information

Pick the bed that you want:

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Pick the wood to use to make the bed:

Maple
Oak
Cherry

Do you want anti-squeak technology built into your bed?

Yes No

Do you want a headboard?

Yes No

If yes, pick your style (the wood will be the same):

Plain
Fancy
Bookcase
Entertainment

Color of mattress:

Pick your matching furniture (Select any two):

Dresser
Night stand
Chest
Book shelve

Do you want rollers on your bed?

Yes No