Stretcher Mattress with Corner Style B

(Please print and complete this form. Then fax it with your order.)

There are about one hundred different shapes and sizes of stretcher mattresses. Although we have dimensions for many of these mattresses, many have already been replaced at least once with an alternate size. Since we want you to receive the correct mattress shape and size, we ask you to complete this form.

Simply measure your existing mattress. Make any needed changes to the width and length. Then fill in the blanks with your measurements. Attach this completed form to your purchase requisition/ order. We must receive this completed document from your facility (via email or fax) to process your order. Please specify your mattress color preference on the requisition/ order. Our email address is Our fax number is 817 424-1745.

All stretcher mattresses are custom, made to order and non-returnable.
© 2012 SW Med-Source Inc.  All rights reserved.

The above dimensions are correct.
Your Name _____________________   Facility Name _____________________
Your Signature _____________________   Phone Number _____________________

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