Flag Requests

Select flag size and material

Qty.	Size	Material	Price	Flown over Capitol	Sub-total
	3' x 5'	Cotton	$11.00	Yes ($7.00 per flag) No (Flag Not Flown)
	3' x 5'	Nylon	$10.00	Yes ($7.00 per flag) No (Flag Not Flown)
	4' x 6'	Nylon	$15.00	Yes ($7.00 per flag) No (Flag Not Flown)
	5' x 8'	Cotton	$23.00	Yes ($7.00 per flag) No (Flag Not Flown)
	5' x 8'	Nylon	$20.00	Yes ($7.00 per flag) No (Flag Not Flown)
Shipping & Handling ($4.00 per Flag)					$0.00
Total					$0.00

In Honor of Prefix*

First Name *

Last Name *

Occasion

To Be Flown On Any Date Specific Date

Select Date

Special Instructions

Requester’s Contact Info

First Name *

Last Name *

Phone Number*

E-mail *

Verify E-mail *

Requester’s Address

Street Address *

Street Address (2)

City *

State *

Zip Code *

Shipping Address

Shipping address is the same as requestor’s address

Full Name

Street Address *

Street Address (2)

City *

State *

Zip Code *

Payment Information

You may either Pay Online or by Check

If you would like to pay by Mail, Follow the instructions Below:

Note: This form cannot process transactions, after clicking the submit button you will be able to print off your completed form.

Please print a copy of this form and include it with payment made out to: “Keeper of the Stationery”

Please mail the copy of your request and payment to:

Keeper of the Stationery

c/o U.S. Senator Ed Markey

255 Dirksen Senate Office Building

Washington, D.C., 20510

Check Money Order

Senator Ed Markey