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Home   /   Forms / Flag Request
You may e-mail me by filling out your information and comments below. Otherwise, please call, fax, or write your request to me.


Office of Congressman Jim Gerlach
308 Cannon HOB
Washington, DC 20515

All email inquiries will receive a reply by mail in 10 business days.  
If you have not received a reply to your email in this time,
please contact my office at, .

* First Name
* Last Name
* Address
* City
* State
* Zip Code
Phone Number
* Email Address

Indicate the number of which flag(s) you would like below:
Please note: flag prices are subject to change.

3 X 5 Cotton @ $14.30 each
3 X 5 Nylon @ $12.85 each
4 X 6 Nylon @ $18.55 each
5 X 8 Cotton @ $27.15 each
5 X 8 Nylon @ $23.05 each
Do you want the flag flown over the Capitol? ($4.05)
Do you have a date preference?

If yes, please fill in date (allow 4-6 weeks notice prior to desired date):
 
 
What occasion or person will this flag be for,
as you would like written on the certificate?
 Message
 
Send Flag(s) to (if other than listed above):
Name
Street Address
City
State
Zip
Phone
 
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