Patch & Pin Order Form

Last Name:

First Name:

MI:

Address:

City:

State:

Zip:

Phone:

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 Pins Ordered:

Number of Patches Ordered:

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

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

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