Flag Request Form

Purchaser's name :
Street address :
Address, line 2 :
City :	,   State :
ZIP :	+4

Phone number (for questions regarding your order)  

E-Mail Address  

The next address is where the order will be sent. This information must be filled in.
To copy the purchaser's information into the fields below, click the following checkbox:

Ship To Name :
Street address :
Address, line 2 :
City :	State:
ZIP :	+4

Phone number (for questions regarding delivery problems)  

Size	Material	Quantity Flown Over the Capitol	Quantity NOT Flown Over the Capitol
3'x5'	Nylon	@ $13.05	@ $9.00
3'x5'	Cotton	@ $13.30	@ $9.25
4'x6'	Nylon	@ $17.55	@ $13.50
5'x8'	Nylon	@ $22.05	@ $18.00
5'x8'	Cotton	@ $24.05	@ $20.00

If you choose to have your flag flown over the United States Capitol, please complete the following
information for the certificate. If you have multiple flags to fly, they must all be flown on the same date.
If you have multiple flags to fly on the same date, and you would like different names and/or occasions
to appear on each certificate, please leave the name and occasion information below blank, and use a
separate document to enclose that information.

Flag will be presented to (name as it should appear on the certificate)

Special occasion

* Requested date for flag to be flown

Please submit your request at least five weeks ahead of your desired date.

Clicking on “Calculate Prices” will calculate shipping costs and the total amount due, and will show the
results in the order request page that can be printed for mailing.