| Print this form and mail it to the address below. |
| Your Name: |
________________________________________ |
| Address: |
________________________________________ |
| Daytime Phone Number: |
________________________________________ |
| Address To Send Flag To: |
________________________________________ |
| |
|
| Number/type of flags desired: |
| 3' x 5' nylon . . . . . $ 9.00 |
____________ |
| 3' x 5' cotton . . . .. $ 9.25 |
____________ |
| 4' x 6' nylon . . . . . $ 13.50 |
____________ |
| 5' x 8' nylon . . . . . $18.00 |
____________ |
| 5' x 8' cotton . . . .. $20.00 |
____________ |
| Flying Certification Cost . . . . $4.05 per flag |
____________ |
| (If you want flag flown over U.S. Capitol) |
| Shipping and Handling Cost. . . $ 4.00 per flag |
____________ |
| Total Cost..........$ |
____________ |
| |
|
| Check Number |
____________ |
(Please make checks or money orders payable to
the "Keeper of the Stationery.") |
| |
|
| Name of Person for whom it is to be Flown: |
________________________________________ |
| Special Occasion/Event Flag is to be Flown: |
________________________________________ |
| Date you want Flag to be Flown: |
________________________________________ |
| |
|
| The prices for flags and flag certification are subject to change per the request
of the Keeper of the Stationery. |
| |
Mail this form, along with a check made out to "Keeper of the Stationery",
to:
Attn: Sara Vosberg
Senator Byron L. Dorgan
322 Hart Senate Office Building
Washington, DC 20510 |