Flag Requests

FLAG REQUEST VIA ONLINE PAYMENT

FLAG REQUEST BY CHECK

Select Flag Size and Material

Qty

Size

Material

Price

Flown over Capitol

Sub-total

Qty

Size 3' x 5'

Material Cotton

Price $12.00

Flown over Capitol

($9.00 per flag)

Sub-total $0.00

Qty

Size 3' x 5'

Material Nylon

Price $11.00

Flown over Capitol

($9.00 per flag)

Sub-total $0.00

Qty

Size 4' x 6'

Material Nylon

Price $16.00

Flown over Capitol

($9.00 per flag)

Sub-total $0.00

Qty

Size 5' x 8'

Material Cotton

Price $24.00

Flown over Capitol

($9.00 per flag)

Sub-total $0.00

Qty

Size 5' x 8'

Material Nylon

Price $21.00

Flown over Capitol

($9.00 per flag)

Sub-total $0.00

Shipping & Handling ($8.80 per Flag)

$0.00

Total

$0.00

In Honor of

Prefix *

First Name *

Middle

Last Name *

Suffix

Occasion

To Be Flown On

Any Date

Specific Date

Select Date *

Special Instructions

Information

Prefix *

First Name *

Middle

Last Name *

Suffix

Phone Number

Email *

Verify Email *

Street Address *

Street Address (2)

City *

State *

Zip Code *

Shipping Address

Full Name

Shipping address is the same as requestor’s address

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 Stationery

c/o U.S. Senator Catherine Cortez Masto

204 Russell Office Building

Washington, DC 20510

Check

Money Order

Flag Requests

FLAG REQUEST VIA ONLINE PAYMENT

FLAG REQUEST BY CHECK

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