Tulsa Police Officers’ Memorial Fund
Donation Form

Amount of Donation $_________________________________

Name _____________________________________________

Street Address ______________________________________

City, State, Zip ______________________________________

Is this donation from an individual or a business? _____ Individual _____ Business
     If Business, name of Business _________________________

Is this donation in memory of a specific fallen officer? _____ Yes  _____ No
     If yes, name of officer ______________________________

Is this donation in honor of another party?  _____ Yes _____ No
     If yes, name of other party __________________________

You may print this form and mail it along with your donation in the form of a check, cashier’s check, or money order to:

Triad Bank
P. O. Box 35567
Tulsa, OK 74153
Attn: Tulsa Police Officers’ Memorial Fund

THANK YOU FOR YOUR DONATION!