Congressman J. Randy Forbes

Virginia’s Fourth Congressional District

Flag Request Form

Updated 8/22/2007

Section A – Requesting Party Information

Today’s Date
Name
Address	City/Zip
Phone ( )	Email

Section B – Flying Instructions

Certificates will be printed exactly as information is given below.

1) Is the flag to be flown over the Capitol? Yes	No (If no, please skip to Section C)

2) To be flown in Memory of: Honor of:

3) On the occasion of:

4) Date to be flown: ASAP

Orders must be received at least three weeks prior to date of flying. Orders received after the three-week deadline may not be flown on the date specified, but will be flown as soon as possible. Special requests will be handled on an individual basis.

Section C – Quantity and Payment Information

Flag Type	Quantity	Subtotal
3X5 Nylon ($9.00 each)	$
4X6 Nylon ($13.50 each)	$
5X8 Nylon ($18.00 each)	$
Capitol Flying Fee ($4.05 per flag)	$
Postage ($3.20 per flag)	$
TOTAL	$
Check Number
Checks must be: a) Payable to the “Office Supply Service Account of J. Randy Forbes”; b) Written for the exact amount; c) Dated on or around the flying date. Checks will not be cashed until order is shipped.

Section D – Shipping Instructions

Name
Address	City/Zip

Allow an additional 6-8 weeks from flying date for the Capitol processing and shipping.

Section E – Submission

Mail request and check to Congressman Forbes’ nearest district office. Please do not mail flag requests to Washington, DC as mail delays will add an additional 4 weeks processing time to your flag request. Thank you!

Congressman J

camirpas

2007-09-12

Jessica Mancari

House Information Resources