Donation Form

Please print, fill-in and mail this form with your contribution to:

Disabled Police Officers Counseling Center, Inc.

c/o Terry Morrison, President

222 Government Avenue, Suite C

Niceville, Florida 32578 

If you have any questions please feel free to call us at 1-850-729-0009.

DPOCC is a 501(c)(3) non-profit organization.  We truly appreciate your willingness to support our efforts and we will provide you with a donation receipt for your tax purposes.  All contributions are tax deductible to the full extent of the law.  

Name: _________________________________________________________

Organization: ____________________________________________________

Address: _______________________________________________________

City, State, Zip: __________________________________________________

Daytime Phone: __________________________________________________

E-Mail: _________________________________________________________

Check enclosed:  $ _________ (US dollars only please, made payable to DPOCC)

Comments:

Thank you for your support!

Serving Law Enforcement Across the Nation

A 501(c)(3) Charitable Organization Serving Since 1992