Please print out this form and mail, along with a check or money order made out to: "The Keeper of the Stationery", to:
Office of Senator Max Baucus
United States Senate
Washington, DC 20510
(202) 224-2651
Your name and Phone Number:__________________________________________
Your address:________________________________________________________
___________________________________________________________________
The following information will be included on a certificate included with the flag:
Name of recipient (Person flag is to be flown for):_________________________
Address flag should be mailed to:__________________________________
______________________________________________________
Occasion (if any):_____________________________________________________
___________________________________________________________________
Date flag is to be flown over the Capitol (if applicable):______________________
Number/type of flags desired:
Type
|
Quantity
|
Total
|
3' x 5' Nylon
|
__________ x $9.00
|
$____________
|
3' x 5' Cotton
|
__________ x $9.25
|
$____________
|
5' x 8' Nylon
|
_________ x $18.00
|
$____________
|
5' x 8' Cotton
|
_________ x $20.00
|
$____________
|
Flying and certification
|
___________ x $4.05 (per flag)
|
$____________
|
Shipping and Handling
|
___________ x $4.00 (per flag)
|
$____________
|
|
|
Grand Total
|
$_____________
|
|