Lafayette PD Fallen Heroes Fund Contribution Form

Contribution Form

The purpose of this Fund is to provide some financial relief to any City of Lafayette Police Department officer or employee, or any family of any City of Lafayette Police Department officer or employee, killed or wounded in the line of duty.

You can make a tax-deductible contribution with your debit or credit card by filling out the form below.

To drop off or mail a check:Community Foundation of Acadiana, 1035 Camellia Blvd., Ste. 100, Memo: Lafayette PD Fund, Lafaytte, LA 70508.

Name*

First NameLast Name

Company Name - (If not applicable, please type "None")*

Phone Number*

Area CodePhone Number

E-mail*

Comments

Please enter the amount you wish to donate.*

USDFallen Heroes Fund

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Please note that standard credit card transaction fees will be assessed from your total contribution.