Hearts of Gold Order Form

							                             Hearts of Gold Order Form
 The monies produced through the sale of Hearts of Gold items, with the exception of the
    Heart’s Desire Scrip Program, benefit the Hearts of Gold assistance fund. These
 monies are used to provide financial assistance to Tucson Police Department Hearts of
 Gold members and their families when dealing with a serious accident or serious illness.
       For more information visit: www.tucsonpolicefoundation.org/heartsofgold


 We Care Bears

 Size: Approximately 8” tall                                                          # Bears        Total Bear Cost
                                                                                                         (# bears x $10)
 Cost: $10
                                                                                                     $




 Got Criminals? Shirts

 Available sizes: S, M, L, XL, XXL, XXXL
 Cost: $10


                                                                          front                      back

                                                                                      # Shirts           Total Shirt Cost
Color         S              M          L             XL          XXXL    XXXL
                                                                                      Ordered        (# shirts ordered x $10)

Grey                                                                                                 $
Black                                                                                                $


        Completed forms can be emailed to HeartsofGold@tucsonaz.gov or faxed to 791-4642.
           You will be contacted via phone or email when your order is ready for pickup.

        Name
         PR#
  (dept. members only)

  Contact Number                 -          -           ext.
  Desired Pick up                               1310 W. Miracle                                            9670 E. Golf
                         270 S. Stone                              4410 S. Park   1100 S. Alvernon
      Location                                       Mile                                                     Links
   (choose one)
     Total Cost
   (add all Total Cost   $
         boxes)

   Payment is due upon receipt. We can only accept cash or checks. If paying with cash, exact
   amount is necessary, as the pick up locations do not have the ability to make change. Make
                              checks payable to Hearts of Gold.

                                                                                                          Updated: 04/29/10