Flag Request

You may e-mail me by filling out your information and comments below. Otherwise, please call, fax, or write your request to me. After filling out the electronic form, please send your checks to the address listed below. Flag requests will only be processed once a check has arrived.

Honorable Michael Burgess Stationary Account
Attn: Whitney Thompson
1721 Longworth
Washington, DC 20515

* First Name

* Last Name

* Address

* City

* State

* Zip Code

Phone Number

* Email Address

Indicate the number of which flag(s) you would like below:
Please note: flag prices are subject to change.

3 X 5 Cotton @ $14.30 each

3 X 5 Nylon @ $12.85 each

4 X 6 Nylon @ $18.55 each

5 X 8 Cotton @ $27.15 each

5 X 8 Nylon @ $23.05 each

Do you want the flag flown over the Capitol? ($4.05) YesNo

Do you have a date preference? YesNo

If yes, please fill in date (allow 4-6 weeks notice prior to desired date):

What occasion or person will this flag be for,
as you would like written on the certificate?

Message

Send Flag(s) to (if other than listed above):

Name

Street Address

City

State

Zip

Phone