A.W. Scopes - Kaleidoscope Order Form
	first & last name:
	company name:
	address:
	city:
	state/province:
	zip code:
	country:
	e-mail:
	telephone:
	fax:

	Scope Name	quantity

	NOTES: (special shipping instructions, how you heard of A.W. Scopes, any other relevant info...)

	MAIL TO:		or FAX to: (413) 618-4141
	Arny Weinstein
	A.W. Scopes		QUESTIONS?
	464 Park Ave.
	Yonkers, NY 10703		e-mail: mail@awscopes.com
	USA		phone: (914) 476-1011