Flag Request Form

Contact information

Date: Name of Contact Person: Address: City: State: Zip Code: Email Address: Phone Number:

Make all checks payable to: Keeper of the Stationery

Mail checks to: Senator Jerry Moran United States Senate Washington, DC 20510 Attn: Flag Coordinator

Flags FLOWN over the U.S. Capitol Flags NOT FLOWN over the U.S. Capitol Size Material Unit Price Qty 3' x 5' Nylon $32.80 4' x 6' Nylon $36.80 5' x 8' Nylon $45.80     Total: $0.00 Size Material Unit Price Qty 3' x 5' Nylon $23.80 4' x 6' Nylon $27.80 5' x 8' Nylon $36.80     Total: $0.00

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:

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:

Name: Address: City: State: Zip Code:

**Important** Normal processing time for flags flown over the Capitol is 4 to 6 weeks. All prices listed are at cost, and no profit is incurred.