Flag Requests

Please note: Any flags requested flown after November 1st, 2016 will have a flag request flying price of 7 dollars. This price change will be reflected in pricing estimates after 11/1/16. Sorry for the inconvenience.

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)
	3' x 5'	Nylon	$10.00	Yes ($7.00 per flag)
	4' x 6'	Nylon	$15.00	Yes ($7.00 per flag)
	5' x 8'	Cotton	$23.00	Yes ($7.00 per flag)
	5' x 8'	Nylon	$20.00	Yes ($7.00 per flag)
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
Name
Street Address *
Street Address (2)
- City *
- State *
- Zip Code *

Payment Information

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 Stationary

c/o Senator Ron Wyden

221 Dirksen Senate Office Bldg.

Washington, D.C., 20510

- Check
- Money Order