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