U.S. FLAG ORDER FORMU.S. FLAG ORDER FORMYour Name ______________________________________
Your Address ____________________________________
Telephone Day(____)_________ Evening(____)_________
| Flag Size | Flag Type | Price of Flag (includes shipping) | Number Ordered | Total |
| 3' x 5' | Cotton | $13.25 each X | ___________ | $__________ |
| 3' x 5' | Nylon | $13.00 each X | ___________ | $__________ |
| 4' x 6' | Nylon | $17.50 each X | ___________ | $__________ |
| 5' x 8' | Cotton | $24.00 each X | ___________ | $__________ |
| 5' x 8' | Nylon | $22.00 each X | ___________ | $__________ |
| Subtotal | $__________ | |||
| If you want your flag flown over the Capitol, add $4.05 for each flag | Number to be Flown | ___________ | X 4.05 per flag | $__________ |
Total |
$_________ |
If you want your flag flown over the Capitol please provide the date _____________
Name of person or organization to whom the flag will be presented:___________________________
Occasion (Birthday, Anniversary, Etc.)________________
If your flag is being flown over the Capitol, do you want your name listed on the certificate as the presenter of the flag? Yes ______ No ______
Make your check payable to: Keeper of the Stationery (Checks or Money Orders Only--No Cash)