To Order a Flag:
Flag Request form below may be printed out and used to submit request.  Constituents may send requests via fax or email to:

Congressman Virgil H. Goode, Jr. Flag Requests
Attn:  Joan Adams  (202-225-4711)
joan.adams@mail.house.gov
Fax- (202)225-5681


To avoid mail delays, please send all written requests and checks payable to Virgil Goode Office Supply Account to our district office at:
70 East Court St., Suite 215
 Rocky Mount, VA 24151  


Flag Request Form



Date:		    _________________________
Name:		    _________________________
Phone:  	    _________________________
Address: 	    _________________________
 	      	    _________________________
Address Flag to be mailed to:   	   _________________________
(if different from requestor's address)   _________________________



Flag Size			Quantity
3x5 Cotton	  	___________________
3x5 Nylon		___________________
4x6 Nylon		___________________
5x8 Cotton		___________________
5x8 Nylon		___________________
Total			___________________


Flag to be in honor or in recognition of:

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________