Name:
		Email Address:
		Mailing Address:
		Pillow Name:
		Type:		Pillow Sampler
		Required Information:			(Some of our pillows require your input in order to personalize them. Please use this space to in order to get the best pillow possible!)

	After filling out this form please print it and fax or mail it to. After receiving order, you'll be called back to further discuss your custom pillow:
	Scissor-Works 5920 Bridle Lane Lincoln, Nebraska 68516 Voice/Fax: 402-438-8803
	Questions or Comments, please email us at scissorworks@hotmail.com

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