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