Flag Request Form

I am pleased to assist constituents of the 23rd District of Florida in requesting American Flags flown over the Capitol Building and dedicated to any person, organization or event of their choice.

Flags can also be flown on any specific date, including weekends and holidays. Each Flag is individually boxed and includes a certificate of dedication.

There are some nominal fees associated with flying a flag over the Capitol, and the price varies according to the size and material of the flag you request. This cost will be passed on to you.

Once your request is received my staff will contact you to verify your request and give you necessary payment information.

Prefix*:

First Name*:

MI:

Last Name*:

Suffix(Jr., Sr.):

Street Address*:

City*:

State*:

Zip Code*:

Phone:

E-mail*:

	Choose a flag you want to order:
	3x5 Nylon ($9.00)
	3x5 Cotton ($9.25)
	4x6 Nylon ($13.50)
	5x8 Nylon ($18.00)
	5x8 Cotton ($20.00)

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*:

Your Message:

Regrettably, I am unable to reply to any email from constituents outside of the 23rd District of Florida.

All fields with a red * are required.

Broward County Office

2701 W. Oakland Park Blvd
Suite 200
Fort Lauderdale, FL 33311
Tel: (954) 733-2800
Fax: (954) 735-9444
Hours: 9:00 am – 5:00 pm
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Washington Office

2353 Rayburn Office Building
Washington D.C. 20515
Tel: (202) 225-1313
Fax: (202) 225-1171
Hours: 8:30 am – 6:00 pm
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Palm Beach County Office

Mangonia Park Town Hall
1755 E. Tiffany Dr.
Mangonia Park, FL 33407
Tel: (561) 881-9618
Fax: (561) 881-9879
Hours: 9:00 am – 5:00 pm
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