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The Office Of Utah Congressman Jim Matheson - Flag Purchase Form

Name:____________________________________________
Address:____________________________________________
City:____________________________________________
Zip:_____________-______
Day Phone: (       )  _______________
Evening Phone: (       )  _______________
E-mail Address:____________________________________________

Flag Certificate Information:
Name of individual flag is to be flown for:
____________________________________________
Occasion for which flag is flown (if any):
____________________________________________
Particular date flag is to be flown over the Capitol (if any):
____________________________________________
Flag Order Worksheet
Flag Type Price Each Quantity Total:
3x5 cotton $19.05 ($9.25 flag) + ($5.75 shipping) + ($4.05 flying fee)    
3x5 nylon $18.80 ($9.00 flag) + ($5.75 shipping) + ($4.05 flying fee)    
4x6 nylon $23.30 ($13.50 flag) + ($5.75 shipping) + ($4.05 flying fee)    
5x8 cotton $29.80 ($20.00 flag) + ($5.75 shipping) + ($4.05 flying fee)    
5x8 nylon $27.80 ($18.00 flag) + ($5.75 shipping) + ($4.05 flying fee)    
GRAND TOTAL  =   
Make checks payable to "Jim Matheson Office Supply Account." (Your order will not be processed without a signed check). Please allow 8-10 weeks for delivery.
Mail To:
Congressman Jim Matheson
Attn: Flags
240 East Morris Avenue #235
South Salt Lake, UT 84115