HPROA Donation Form

Your donation is an important contribution to assisting retired Houston Police Officers in many areas, including:

  • Loaning of no-cost medical equipment for those retirees and their family members who cannot afford these important items
  • Efforts on the state and local levels to retain the every-eroding pension benefits
  • Working with City officials in order to retain affordable healthcare insurance and Medicare premiums
  • Funeral-service presentations (solid brass plaque and presentation binder)
  • Immediate-need funeral assistance for those without funding
  • And much more.

DONATION AMOUNT  *
$25 $50 $100 $200      Other-Specify Amount $

CONTACT INFORMATION
Name*

Organization / Company
   Telephone

E-mail Address*

REASON FOR DONATION (PLEASE CHECK ONE)
Donation in memory of

I just want to assist retired Houston Police Officers by donating to the HPROA        
Donation for a specific reason (please specify in comments below)
     (for example: Family Assistance Committee, etc)

Comments (Optional)

Donation Total: $

If paying by check, please complete and print this form and Mail to:  

HOUSTON POLICE RETIRED OFFICERS ASSOCIATION
P.O. BOX 130787, HOUSTON, TX  77219

You will be prompted to print this form upon submission.

Method of Payment:
 Check    Credit / Debit Card

Credit / Debit Card Information (all fields required)
Card Type

Cardholder's First Name

Cardholder's Last Name

Credit Card Number

Exp Date
(e.g.: 05/2021)
Security Code

 

Cardholder's Billing Street Address

Billing City

Billing State
(2-digit state code)
Billing Zip Code

Billing Country
(2-digit country code)

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NOTE:
If paying by check, please print this form, complete the “Donor” information, and Mail to:  

HOUSTON POLICE RETIRED OFFICERS ASSOCIATION

P.O. BOX 130787, HOUSTON, TX  77219