Richard G. Lugar
Flag Order Form

Name __________________________________________________________

Address ________________________________________________________

City, State, Zip ___________________________________________________

Phone __________________________________________________________

E-Mail Address ___________________________________________________

Date Flag to be flown _______________________________________________
(If Applicable)

Flag to be flown for ________________________________________________

Occasion ________________________________________________________

Pricing:

Size type quantity

3x5 nylon __________ x $9.00 = __________
3x5 cotton __________ x $9.25 = __________
5x8 nylon __________ x $18.00 = __________
5x8 cotton __________ x $20.00 = __________

Flying & certification __________ x $4.05 = __________
Shipping & handling __________ x $4.00 = __________

Grand Total = __________

Check or money order should be made payable to Keeper of the Stationery and sent with completed flag form to:

The Honorable Senator Richard G. Lugar
Attention: Flag Coordinator
306 Hart Senate Office Building
Washington, DC 20510-1401

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