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Flag Request Form
Office of Representative André Carson
To order a flag, please complete and print out the form below. Please send this completed form and a check made payable to Office Supply Service - IN 0780 to my office:
Rep. André Carson
Attn: Flag Request
2453 Rayburn House Office Building
Washington, D.C. 20515
Name: _________________________
Street Address: _________________
Phone Number: _________________
Email Address: _________________
Please mail flag to: (If different from name and address above)
Name: _________________________
Street Address: _________________
_______________________________
_______________________________
Please choose the type of flag you prefer:
| Flag Type |
Flag Cost |
Flying Fee |
Postage |
Total |
Quantity |
Total |
| 3'x5' cotton |
$9.25 |
$4.05 |
$6.16 |
$19.46 |
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| 3'x5' nylon |
$9.00 |
$4.05 |
$5.35 |
$18.40 |
|
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| 4'x6' nylon |
$13.50 |
$4.05 |
$6.16 |
$23.71 |
|
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| 5'x8' cotton |
$20.00 |
$4.05 |
$7.37 |
$31.42 |
|
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| 5'x8' nylon |
$18.00 |
$4.05 |
$6.16 |
$28.21 |
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Total: $ |
PLEASE NOTE: If you do not wish to fly the flag over the Capitol, please check box here [ ___ ], and the flying fee should be excluded from the total.
If the flag is to be flown over the Capitol, please select the type of certificate you prefer: (circle only one)
i. Flown For
ii.Present To
iii. In Recognition of
iv. In Memory of
v. To Commemorate
If applicable, please provide the following information:
i. For whom is the flag being flown for: ____________________
ii. For what occasion is the flag being flown for: ____________________
iii. Is there a specific date for the flag to be thrown? [ YES ] or [ NO ] (circle one)
If Yes, please provide the date: _____/______/______
Please be aware that the mail security screening process may delay receipt of your request. If you have any further questions regarding a flag order, please contact my DC Office at (202) 225-4011.
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