JimJordan

Flag Request

Name:

Prefix *	First Name *	MI	Last Name *	Suffix (Jr., Sr.)

* Address:

* City:

Zip:

* Phone Number:

* Email:

Size	Fabric	Price Unflown	Price Flown
3 x 5 Feet	Nylon	$13.90	$17.95
3 x 5 Feet	Cotton	$14.95	$19.00
4 x 6 Feet	Nylon	$19.20	$23.25
5 x 8 Feet	Nylon	$23.70	$27.75
5 x 8 Feet	Cotton	$27.05	$31.10

I would like my flag...

Flown on

Flown as soon as possible

Do not fly my flag over the Capitol

Certificate Salutation:

Flown for

Presented to

Flown in Memory of

Flown in Recognition of

Flown in Commemoration of

* Name / Event:

Send the Flags to

Name:

Address:

City / State / Zip:

Check Information

Check Number:

Total Amount:

Download a PDF Form
Download a printable form you can mail or fax to my DC office.

WASHINGTON, DC OFFICE
515 Cannon House Office Bldg Washington, D.C. 20515 T (202) 225-2676 F (202) 226-0577
MANSFIELD OFFICE
24 West Third Street, Room 314 Mansfield, OH 44902 T (419) 522-5757 F (419) 525-2805
LIMA OFFICE
3121 West Elm Plaza Lima, OH 45805 T (419) 999-6455 F (419) 999-4238
FINDLAY OFFICE
100 East Main Cross, Suite 201 Findlay, OH 45840 T (419) 423-3210 F (419) 423-3233