Flag Request

Name:
Street Address: 
Daytime Phone Number: 
Email Address: 
Please mail flag to (if different from name and address above):
Name:
Street Address: 
Please Select Your Choice Below:

Please send payment in form of a check or money order made out to:
Representative Bob Inglis
United States House of Representatives
330 Cannon HOB
Washington, D.C. 20515
Once we receive your order online we will begin to process your order, however, the flag/flags will not be shipped until payment has been received.
Flown over the Capitol (enter number of flags) Not Flown over the Capitol (enter number of flags)
3 ft. x 5 ft. Cotton - $13.30* 3 ft. x 5 ft. Cotton - $9.25*
3 ft. x 5 ft. Nylon - $13.05* 3 ft. x 5 ft. Nylon - $9.00*
4 ft. x 6 ft. Nylon - $17.55* 4 ft. x 6 ft. Nylon - $13.50*
5 ft. x 8 ft. Cotton - $24.05* 5 ft. x 8 ft. Cotton - $20.00*
5 ft. x 8 ft. Nylon - $22.05* 5 ft. x 8 ft. Nylon - $18.00*
 ***SHIPPING COST: Per flag, please add the following shipping cost to your total: 3x5 cotton add ($4.80); for one 3x5 nylon add ($4.05); for one 4x6 nylon add ($4.80); for one 5x8 nylon add ($4.80); for one 5x8 cotton add ($6.40).
If Flag is to be Flown over the Capitol (choose one for the certificate):
A) Flown for
B) Present to
C) In Recognition of
D) In Memory of
E) To Commemorate
If applicable, flown for who or for what occasion:
If Flag is to be Flown on a specific date:
Please fly on: