Purchaser's name:
Street address:
Address, line 2:
City:	,   State:
ZIP:	+4

Phone number (for questions regarding your order) 

The next address is where the order will be sent. This information must be filled in. To copy the purchaser's information into the fields below, click the following checkbox:

Ship To Name:
Street address:
Address, line 2:
City:	State:
ZIP:	+4

Phone number (for questions regarding delivery problems) 

Size	Material	Quantity Flown Over the Capitol	Quantity NOT Flown Over the Capitol
3'x5'	Nylon	@ $13.05	@ $9.00
3'x5'	Cotton	@ $13.30	@ $9.25
4'x6'	Nylon	@ $17.55	@ $13.50
5'x8'	Nylon	@ $22.05	@ $18.00
5'x8'	Cotton	@ $24.05	@ $20.00

If you choose to have your flag flown over the United States Capitol, please complete the following information for the certificate.If you have multiple flags to fly, they must all be flown onthe same date. If you have multiple flags to fly on the same date,and you would like different names and/or occasions to appear oneach certificate, please leave the name and occasion informationbelow blank, and use a separate document to enclose that information.

Flag will be presented to (name as it should appear on the certificate)

Special occasion

* Requested date for flag to be flown

Please submit your request at least five weeks ahead of your desired date.

Fill out the following form an click 'calculate' at the bottom for a printable order form and mail along with your check made out Ron Kind Office Supply Account to:

The Honorable Ron Kind
Attn: Flags
1406 Longworth House Office Building
Washington, DC 20515