Houston Police Retired Officers Association

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 ever-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.

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

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.: 05/2022)
Security Code

Cardholder's Billing Street Address

Billing City

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

Billing Country
(2-digit country code)

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