RETIRED & DISABLED POLICE OF AMERICA

PATCH & PIN ORDER FORM
Name:
Address:
City:
State: Zip Code:
Telephone Number:
Patches are $5.00 each - 2 for $9.00 - More than 2 are $4.00 each

Pins are $5.00 each - 2 for $9.00 - More than 2 are $4.00 each

Number of patches ordered:

Number of pins ordered:

Print this form and mail it along with your check or money order, payable to RDPOA, to:

Retired & Disabled Police of America
1317 N. San Fernando Blvd., #319
Burbank, CA 91504-4272

You must be a member of the Retired & Disabled Police of America to order this Item.