Flag Request Form

Purchase a U.S. flag through my office. There is no limit on the number of flags you may order. You may also request that your new flag be flown over the Capitol for an additional charge. Flags may be flown for a particular person, event, or organization, and may be flown on a specific date. A certificate of recognition is included with each flag.

* indicates required information.

Your Information

Prefix: Select One Mr. Mrs. Miss. Ms. Dr.

First Name:*

Middle Initial:

Last Name:*

Suffix:

Street address:*

Address, line 2:

City:*

State:* Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York North Carolina Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming

ZIP:* -

Phone number: (for questions regarding your order)

E-mail Address:*

Shipping Address

The next address is where the order will be sent. This information must be filled in.

Click the following checkbox to copy the purchaser's information into the fields below.

Prefix: Select One Mr. Mrs. Miss. Ms. Dr.

First Name:*

Middle Initial:

Last Name:*

Suffix:

Street address:*

Address, line 2:

City:*

State:* Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York North Carolina Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming

ZIP*: -

Phone number (for questions regarding delivery problems)

Number of Flags

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.

Care of the Flag

Most outdoor flags can be washed in mild detergent and thoroughly rinsed. Indoor and parade flags should be dry-cleaned. Damaged flags can be repaired and utilized as long as the overall dimensions are not noticeably altered. American Legion Posts and local governments often have facilities to dispose of unserviceable flags. Store your flag in a clean, well ventilated area.

Additional Information

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

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 6 weeks ahead of your desired date.