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Flag Request Form
My office can provide United States flags to residents of Kentucky's 2nd District.
Optionally, the flags can be flown over the U.S. Capitol Building. Each flag that is flown comes with a certificate detailing the occasion you provide.
Your Name:
Prefix
First Name *
MI
Last Name *
Suffix
(Jr., Sr.)
* Your Address:
* City:
State:
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip:
Phone Number:
* Email:
Recipient's Name:
Prefix *
First Name *
MI
Last Name *
Suffix
(Jr., Sr.)
* Shipping Address:
* City:
State:
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip:
Size
Fabric
Quantity Flown
over the Capitol
Quantity NOT Flown
over the Capitol
TOTAL
3'x5'
Nylon
@ $
13.05
@ $
9.00
3'x5'
Cotton
@ $
13.30
@ $
9.25
4'x6'
Nylon
@ $
17.55
@ $
13.50
5'x8'
Nylon
@ $
22.05
@ $
18.00
5'x8'
Cotton
@ $
24.05
@ $
20.00
Subtotal
S & H
TOTAL
Date to be Flown:
(at least three weeks from this date)
Required certificate text:
This is to certify that the accompanying flag was flown over the United States Capitol on [date] in honor of...
* Continue Message: