Mail Order Flag Request

Mail-Order Form

Note: Fields marked with an * are required.

Order Date *

Your Name

Prefix *

First Name *

Last Name *

Your Contact Information

Address 1 *

Address 2

City *

State *

ZIP *

Email *

Phone *

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	$15.00	Yes ($9.00 per flag)	$0.00
	3' x 5'	Nylon	$14.00	Yes ($9.00 per flag)	$0.00
	4' x 6'	Nylon	$18.00	Yes ($9.00 per flag)	$0.00
	5' x 8'	Cotton	$28.00	Yes ($9.00 per flag)	$0.00
	5' x 8'	Nylon	$27.00	Yes ($9.00 per flag)	$0.00
Shipping and Handling ($9.80 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.

1. Name of the person/organization as you want it to appear on the certificate *:

2. If the flag is being flown to commemorate a special occasion, such as a retirement, graduation, anniversary, or birthday and if you want that occasion mentioned in the flag certificate, please list that occasion here:

3. If you want the flag flown over the Capitol on a specific date, please designate that date here (mm/dd/yyyy):

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:

Prefix

First Name

Last Name

Address 1

Address 2

City

State

ZIP

Mail Order Flag Request

Mail-Order Form

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