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Flag Request Form

My office can provide United States Flags to residents of the 13th District.


These flags can also be flown over the U.S. Capitol building. Each flown flag comes with a certificate with the date flown and the occasion being honored. If you would like to specify a date, please make your request at least 3 weeks in advance of the date you would like.

Your Name:
Prefix First Name * MI Last Name * Suffix (Jr., Sr.)
* Your Address:
* City: State: Zip:
Phone Number:
* Email:
Recipient's Name:
Prefix * First Name * MI Last Name * Suffix (Jr., Sr.)
* Shipping Address:
* City: State: Zip:

Size Fabric Quantity Flown
over the Capitol		 Quantity NOT Flown
over the Capitol		 TOTAL
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
Subtotal
S & H
TOTAL

Date to be Flown: (at least three weeks from now)

Required certificate text:
This is to certify that the accompanying flag was flown over the United States Capitol on [date] in honor of...
* Continue Message:


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