NAME: ___________________________________________

ADDRESS: _________________________________________________________________

CITY: _____________________________ STATE: ______  ZIP: _______________

REQUEST CONTACT NAME AND PHONE NUMBER: _______________________________

___________________________________________________________________________

If flag is to be flown over the Capitol, complete the following for use on the flag certificate:

Date you would like your flag flown over the Capitol: ________________________________

(If date is specified, order should be received four weeks prior to the date on which flag is to be flown.)

Person(s) or organization(s) for whom the flag will be flown:

____________________________________________________________________________

Occasion (if any): _____________________________________

The prices of the flags are as follows:

Size Quantity Type Total
3' x 5' x $9.00 Nylon Flag $
3' x 5' x $9.25 Cotton Flag $
5' x 8' x $18.00 Nylon Flag $
5' x 8' x $20.00 Cotton Flag $
Flying & Certification x $4.05/flag ***************** $
Shipping & Handling x $4.00/flag ***************** $
Order Total $


Please make your check or money order payable to "Keeper of the Stationery" and return with completed form to the following address:

Senator Dianne Feinstein
ATTN: Flag Request
331 Hart Senate Office Building
Washington, DC 20510-0504

Due to the high volume of requests please allow 8-10 weeks for processing and delivery.