SchureMed Bid Request

Please complete the required fields below. Please specify your selected products and
indicate the quantities needed. We will return your quote promptly.

*Required Fields

*	Your Name
*	Facility/Company Name
	Account Number
*	Phone Number
*	Email Address
	Bid Request Info
	Is this request for new construction or renovation of an operating room? If so, please enter the anticipated date.	Day Month Year
	Number of competitive bids
	Is this request for a budgetary requirement? If so, please enter the budgetary-anticipated purchase date	Day Month Year
	Special Instructions for Bid Request