PLEASE FILL OUT THE APPLICATION, PRINT IT OUT AND MAIL OR FAX IT TO US AT THE ADDRESS AND NUMBER BELOW
   
Department Name
Street Address
City
 State Zip
Chief"s Name
Contact Person
Contact's Address
City
 State Zip
Contact's Phone
- - Contact's Fax - -
Please tell us about your city.
How many officers, square miles, population, etc. :
Your Department
Contact Person
 
QUESTION 1
Please list the items and quantities of equipment you are requesting.
Please note: "anything you have on hand" is NOT an item.
Please list them in order of importance to your department.
Item 1
Quantity
Item 2
Quantity
Item 3
Quantity
Item 4
Quantity
QUESTION 2
Will this be used to replace existing equpment?
Yes No

QUESTION 3
If you requested bulletproof vests, please provide a breakdown of how many of the vests will be used by full time officers and how many for reserves?

For Full Time Officers For Reserve Officers
QUESTION 4
How many FULL TIME Officers does your department employ?
QUESTION 5
How many units does your department run?
COMMENTS:
The name of person completing this form

 

Signature of Chief of Police _________________________________________________________________________
(required for consideration)

Todays Date

Please Fax Completed Form to: Jim Bob Conner at (281) 994-2634

or Mail to:
USMPA EQUIPMENT REQUEST
1304 Langham Creek Drive, Suite 324, HOUSTON, TX 77084

Should you have any questions regarding the process, feel free to email me at jrc@usmpa.org
or call the numbers listed above, or toll free (877) 800-5821.