Flag Request

Prefix First Name MI Last Name Suffix (Jr., Sr.)
  Address:
City: State: Zip:
Email:
Phone:

  
Choose a flag you want to order:
3x5 Nylon ($17.85)  *this size free for military retirement purposes 
3x5 Cotton ($21.55)
4x6 Nylon ($25.80)
5x8 Cotton ($35.55)
5x8 Nylon ($30.30) 

(Checks should be made out to "House Office Supply" and mailed separately to the Washington, DC office--2111 Rayburn House Office Building, Washington, DC 20515).

Would you like your flag to be flown over the Capitol?     
If it is important for this flag to be flown on a particular day, enter that day here:   

If it is important for you to receive this flag by a certain date, enter that date here:
  

The following information will be included on the Congressional Certificate:

Occasion:
Name:
Comments: