North American Cockatiel Society Store Order Form

Tiel Flying in Heart	Tiel sitting in Heart	Chef 'Tiel Apron

*Item(s)*	*Quantity*	*Size (Circle)*	Custom? (Y/N)	*Price Each*	*Total Price*
Tote Bag:
Cockatiel sitting in heart				$24.00
Cockatiel flying in heart				$24.00
T-Shirt:
Cockatiel sitting in heart		M, L, XL, 2X		$35.00
Cockatiel flying in heart		M, L, XL, 2X		$35.00
Sweatshirt:
Cockatiel sitting in heart		M, L, XL, 2X		$45.00
Cockatiel flying in heart		M, L, XL, 2X		$45.00
Polo style shirt:
Cockatiel sitting in heart		M, L, XL, 2X		$45.00
Cockatiel flying in heart		M, L, XL, 2X		$45.00
Apron				$24.00
TOTAL

First Name: ________________________ Last Name: __________________________

Street Address: _________________________________________________________

City: _____________________________ State _________ Postal Code ____________

Area Code ( _____ ) Phone Number: ______ - ________ E-Mail: ___________________

All items are airbrushed by Kathy Breychak. Customized cockatiel pictures are available on the T-Shirts, Sweatshirts and Polo Shirts. It is important that you send several good, clear photos of the subject to be painted. The portrait will only be as good as the pictures received. These photos are for reference only and will be returned to you upon request. A written description, provided below, will also be helpful.

If customization is required, please provide a description of the cockatiel:

_____________________________________________________________________

_______________________________________________________________________

$5.00 from each item ordered is donated to the North American Cockatiel Society. Payment in full is due at placement of order. Please allow from 2 to 3 weeks for delivery of shirts, and 4-6 weeks for tote bags.

Shipping is included in above items. Please make checks out to NACS and send to:

NACS Sales Store
P.O. Box 143
Bethel, CT 06801-0143

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