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Flag Request

 

Flag Requests
Name______________________________________________

Address___________________________________________

City,State___________________________________________

Zip Code____________________

Below, please indicate if you want the flag flown over the United States Capitol
If yes, request an upcoming date.

(Yes) or (No) ________

________________________________________
(Requested Date)

Each flag has a certificate of authenticity. On this certificate, you may indicate specifically a special dedication or statement below.

Checks or Money Orders Only! With the correct amount, please make your check or money order payable to: House Office Account #OH1160

Flag Size Price Mailing AOC Charge Total

____3X5 Nylon $9.00 + $3.00 + $4.05 $__________

____3X5 Cotton $9.25 + $3.00 + $4.05 $__________

____4X6 Nylon $15.50 + $3.00 + $4.05 $__________

____5X8 Nylon $18.00 + $3.00 + $4.05 $ ___________

____5X8 Cotton $20.00 + $3.00 + $4.05 $___________

Please send your check or money order with this form to:
Congresswoman Stephanie Tubbs Jones
1009 Longworth HOB
Washington, D.C. 20515
Fax #(202) 225-1339