Dorel Asia Information

* Required Field

First Name: *

Last Name: *

Street Address: *

Format: 123 Main Street
P.O. Boxes are not allowed.

Apartment:

City: *

State: *

If you live outside of the United States, please contact customer support at 1-800-295-1980 for instructions on how to obtain your free kit.

Zip Code: *

Email Address:

Phone: *

Format: XXX-XXX-XXXX

Model number can be located on the label on the bunk bed - Click here for an example label

Model Number: *

Date Code: *

Format: MM/YYYY

* I hereby certify that I have personally examined the bunk bed that is the subject of this application. The model number and manufacture date I have selected from the list of affected models are the same model number and manufacture date labelled on my bunk bed. By checking this box, I verify under penalty of perjury that the foregoing is true and correct, and offer my electronic signature attesting to the truth of what I have stated.

Please indicate how you heard about the safety notice: *

Once you have completed entering the relevant information and submitted your request, you will receive your free kit.

If you have any difficulties completing this form
or have any questions,
please call 1-800-295-1980