Please
return to:
Senator Ken Salazar
702 Hart Senate Office Building
Washington, D.C. 20510
Attention: Jeffrey Phillips |
1. Please print out this form, fill it in, attach a check for the correct amount and mail it to the address at the top of the page. The check should be made
out to "Keeper of the Stationery."
|
Name: _______________________ Street:
_______________________
City: _______________________ State: ____ Zip:
___________
Phone: (Day) _______________________ (Evening)
_______________________ |
|
2. If you would like
to have the flag(s) flown over the Capitol and receive a certificate,
please fill in the section below and include the flying and certification
charge. |
Flag(s) to be flown for: _______________________
Occasion (if any): _______________________
Date you would like your flag(s) flown over the Capitol (if applicable):
________________
|
|
3. If you would like
the flag(s) mailed to someone other than the above name, please fill in
the section below. |
Name: _______________________ Street:
_______________________
City: _______________________ State: ____ Zip:
___________ |
|
4. Select the type
and quantity of flag(s) you would like to purchase. |
Type of flags:
|
Quantity:
|
Total:
|
3 x 5 Nylon Flag
|
________ x $9.00 =
|
$ ________
|
3 x 5 Cotton Flag
|
________ x $9.25 =
|
$ ________
|
5 x 8 Nylon Flag
|
________ x $18.00 =
|
$ ________
|
5 x 8 Cotton Flag
|
________ x $20.00 =
|
$ ________
|
Flying Fee
|
________ x $4.05 (per flag) =
|
$ ________
|
Shipping & Handling Fee |
________ x $4.00 (per flag) = |
$ ________
|
|
|
$ ________
Grand Total
|
|