United States Capitol Flag Order Form
The Legislative Branch Appropriations Act, 1996 (P.L. 104-53), set a fee of $4.05 to cover
the handling cost for each U.S. flag flown over the Capitol. The Senate Rules Committee has
determined each Senator's office must also collect a $4.00 postage fee for each flag mailed
to the constituent.
Instructions
- Print out this form.
- Fill out the amount and size of flag(s) you desire.
- Calculate your cost, including the flag, and postage ($4.00/flag).
If you would like the flag flown over the Capitol please add the
flying fee ($4.05/flag).
- Make out a check or money order for the total cost of your order, payable to the
KEEPER OF THE STATIONERY.
- Enclose your check or money order with your order form and send it to your Senator.
Todays Date: ____/____/____
Where the flag is to be sent:
Name: _____________________________________________________________________
Address: ___________________________________________________________________
City: ___________________________________ State __ __ Zip ___________ - _________
Phone Number of Person ordering the Flag:( ___ )_______________
Do you want this flag flown over the Capitol. Yes:_______ No:______ (if yes please fill
in the information below and add flying fee.)
Name(s) to appear on Certificate:_____________________________________________
Occasion for which flag is being flown:________________________________________
Date Flag is to be flown:____/____/____ (If date is specified, order must be received four
weeks prior to date on which the flag is to be flown.)
| Size |
Fabric |
Cost |
Number |
Certification Fee
($4.05/flag) |
Postage
($4.00/flag) |
Total |
| 3'X5' |
nylon |
$7.50 |
_______ |
_____________ |
_____________ |
_____________ |
| 3'X5' |
cotton |
$8.25 |
_______ |
_____________ |
_____________ |
_____________ |
| 5'X8' |
nylon |
$17.50 |
_______ |
_____________ |
_____________ |
_____________ |
| 5'X8' |
cotton |
$18.75 |
_______ |
_____________ |
_____________ |
_____________ |
|
|
|
|
|
Total |
_____________ |
Amount Enclosed: _______________ Check Number: ___________________________