Mail-Order Form

Note: Fields marked with an * are required.

Your Name
Your Contact Information

Make all checks payable to:
Keeper of the Stationery

Mail checks to:
Flag Requests
c/o Senator Michael Bennet
261 Russell Senate Office Building
Washington, D.C. 20510

Qty. Size Material Price Flown Over Capitol? Sub-Total

3' x 5'

Cotton

$12.00

$0.00

3' x 5'

Nylon

$11.00

$0.00

4' x 6'

Nylon

$16.00

$0.00

5' x 8'

Cotton

$24.00

$0.00

5' x 8'

Nylon

$21.00

$0.00

Shipping and Handling ($6.80 per flag)

$0.00

Total

$0.00

Your Request

Each flag will be accompanied with a certificate signed by the Architect of the Capitol certifying the date that the flag was flown over the United States Capitol and listing the name of the person/persons or organization for whom the flag was purchased. Please provide the following information, as applicable, so that we can include the appropriate information on the flag certificate.

Mailing Address
If you want the flag to be mailed to an address other than the address of the contact person listed above, please provide the following information: