PROMOTIONS

Win a Free Ultramatic Adjustable Bed

Two chances to win a free Ultramatic Adjustable

Bed! No obligations. No purchase necessary.

Limited time offer. Fill in and submit the form below and your name will be automatically included in the draw to be held June 28, 2013. Please be sure to include your phone number so we may contact you if you win the bed. Please note: One entry per household.

To view a list of past winners, click here.

Please click here for full contest details.

Please call 1-888-589-6786
Or Fax us at 1-416-784-4116
Or email us at info@ultramaticsleep.com

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Salutation:	Mr. Mrs. Miss Ms.
Age:	- Please Select - <18 18-39 40-54 55-64 65+
First Name:	*
Last Name:	*
Email Address:	*
Mailing Address:	*
City:	*
Province/State:	- Please Select - Alberta (AB) British Columbia (BC) Manitoba (MB) New Brunswick (NB) Newfoundland and Labrador (NL) Northwest Territories (NT) Nova Scotia (NS) Nunavut (NU) Prince Edward Island (PE) Saskatchewan (SK) Ontario (ON) Quebec (QC) Yukon (YT) Alabama (AL) Alaska (AK) Arizona (AZ) Arkansas (AR) California (CA) Colorado (CO) Connecticut (CT) Delaware (DE) District of Columbia (DC) Florida (FL) Georgia (GA) Guam (GU) Hawaii (HI) Idaho (ID) Illinois (IL) Indiana (IN) Iowa (IA) Kansas (KS) Kentucky (KY) Louisiana (LA) Maine (ME) Maryland (MD) Massachusetts (MA) Michigan (MI) Minnesota (MN) Mississippi (MS) Missouri (MO) Montana (MT) Nebraska (NE) Nevada (NV) New Hampshire (NH) New Jersey (NJ) New Mexico (NM) New York (NY) North Carolina (NC) North Dakota (ND) Ohio (OH) Oklahoma (OK) Oregon (OR) Pennyslvania (PA) Puerto Rico (PR) Rhode Island (RI) South Carolina (SC) South Dakota (SD) Tennessee (TN) Texas (TX) Utah (UT) Vermont (VT) Virginia (VA) Virgin Islands (VI) Washington (WA) West Virginia (WV) Wisconsin (WI) Wyoming (WY) *
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Phone Number:	*
	Please contact me to arrange an Ultramatic adjustable bed in-home consultation
Additional Comments:
Please Send Me:	A free Ultramatic catalogue
How did you hear of us?	- Please Select - Direct Mail Email Friend or Relative Facebook ad Google Ad Internet Search Magazine Newspaper Open and Save Radio TV Other
Employment:	- Please Select - Full Time Part Time Seasonal Unemployed Retired
Reason for Inquiry:	- Please Select - To improve my health Help me sleep more comfortably Just curious
How soon do you plan to buy a new bed?	- Please Select - Within one month Within six months Within a year Not sure
Income:	- Please Select - $0-30,000 $30k-60k $60k-90k $90k-120k over $120k
Do you sleep well now?	yes no
Do you have a physical ailment that interferes with your sleep?	yes no
Would you like to be contacted by:	Sales      Customer Care      In-home Service