Lumpsum Application to be Invoiced

You may donate through our bankdraft option by providing your bank account information and your donation will be deducted from your provided account on the 5th of every month (UNTIL YOU CANCEL). Or you may donate through our “lump sum” option by paying one lump sum per year, you will be sent a renewal via email or mail (your choice).

Step 1 of 2

Donation Type

Lump Sum Type

Renewing Member

New Member

Name(Required)

First Last

Last 4 SSN

Date of Birth(Required)

Date of Hire(Required)

Address(Required)

Street Address City State ZIP Code

Institution (Place of Employment)(Required)

Please put name of your institution/facility. NOT just Department of Corrections.

Institution State(Required)

Job Title(Required)

Employee ID#

Cell Phone(Required)

Email(Required)

Spouse (Person of Choice)

Referred By

Monthly Donation

Name on Account(Required)

First Last

Type of Account(Required)

Routing Number(Required)

Account Number(Required)

How would you like your renewal sent(Required)

Donation Amount(Required)

Please select the amount you would like to donate monthly.

Total

Payment Method

Feed Required: To use the PayPal Checkout field, please create a PayPal Checkout feed for this form.

Jacket(Required)

Do you want a CPO Foundation Jacket for a Donation of $25.00 a Month?

Jacket Size Desired(Required)

Jacket Style(Required)

Signature

Signature(Required)

Date(Required)

Monthly Donation

Signature