Contribution/Order Form

Use this form if you would prefer to make a purchase by MAIL or FAX instead of ordering ONLINE using the "Add to Cart" buttons.

You may type in the blanks below, print the form, then mail it to us, or print it and fill it out by hand. If charging to your credit card (Visa or Mastercard), you may FAX the completed form to us at (845) 426-1525.

(The form is completely optional, you may provide the requested information in writing.)

Item Price (each) Quantity Total $
Bumper Sticker
"Goose Family" Mug

$ 12.00
add $3.50 S&H per mug

"Flock of Geese" Mug

$ 12.00
add $3.50 S&H per mug

Pewter flying goose pin

$   8.00
Hand painted pewter goose pin

$ 22.00
Gold flying goose tie-tack

$ 10.00
Pewter flying goose mini-pin

$   5.00
Pewter goose head pin

$   7.00
Pewter swimming goose pin
 $   7.00
"Flock of Geese" sweatshirt
Size(s):
Adult: Sm/Md L/XL Youth: L 		$ 25.00
"Flock of Geese" t-shirt
Size(s):
Adult: Sm/Md L/XL Youth: L

$ 18.00
"Family of Geese" sweatshirt
Size(s):
Adult: Sm/Md L/XL Youth: L

$ 25.00
"Family of Geese" t-shirt
Size(s):
Adult: Sm/Md L/XL Youth: L

$ 18.00
Prices include shipping and handling unless indicated otherwise
(for continental US only)		   Subtotal
    NY residents:
add 7.25% sales tax
Become a Supporter
(includes pewter flying goose mini-pin and bumper sticker)

$ 24.00

  
    Total

Please make checks payable to: Coalition to Prevent the Destruction of Canada Geese.

Name

Street

City State Zip

E-mail:

Please charge to my: Visa Mastercard

[Note: Name and address on order must be the same as appears on your credit card bill.]

Number: Exp. Date

Signature____________________________________ Amount $

Send to:

Coalition to Prevent the Destruction of Canada Geese
PO Box 917, Pearl River, NY 10965-0917

a committee of Wildlife Watch, Inc.


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