US Flag
Rep. Jim Saxton's Flag Request Form
Please print out this form, enclose check payable to:
Office Supply Account NJ 0330; and mail to: 
Rep. Jim Saxton
100 High St., Suite 301, Mount Holly, NJ, 08060
Attention: Flag Coordinator 

Contact Information 
(please print clearly)

Date of Order:
 
__________________
Contact Person:                                                                                          
Group (if any):                                                                                         
Mailing Address:                                                                                          
                                                                                          
                                                     , NJ                               
Telephone:  Daytime-1                                                                        
  Daytime-2                                                                         
 
If flag is to be flown for a special occasion, please fill out the following:

 
In Whose Name:                                                                                          
Occasion:                                                                                           
Date to be Flown:                                                                                          

Current Flag Prices

Not Flown Flown
  __3x5 nylon $12.85   __3x5 nylon $16.90
  __3x5 cotton $13.20   __3x5 cotton $17.25
  __4x6 nylon  $17.45   __4x6 nylon  $21.50
  __5x8 nylon $21.95   __5x8 nylon $26.00
  __5x8 cotton $24.75   __5x8 cotton $28.80
Prices include postage per flag. 
Flags will be ordered upon receipt of check and order form.  Please allow 8 weeks for delivery.
(Office Use Only)

Total: $ _______     Date Paid: _______    Check # _______    Date Flag Mailed: _______     Staff Initials: _______