Print and
complete the following form. After completion, attach a check or money
order and send to the address listed below.
Representative
Thomas M. Davis, III Flag Order Form
| Name
Of Flag Requestor: |
_________________________________ |
| Address: |
_________________________________ |
| City,
State, Zip: |
_________________________________ |
| Home
Phone: |
_________________________________ |
| Work
Phone: |
_________________________________ |
| Flag
To Be Flown For: |
_________________________________ |
| Address: |
_________________________________ |
| City,
State, Zip: |
_________________________________ |
| Date
Flag Is To Be Flown: |
_________________________________ |
| Occasion
(If Any): |
_________________________________ |
| Flag
Should Be Mailed To: |
___Requestor |
___Recipient |
| Size
|
Material |
Quantity |
Shipping
|
Flying/Certification |
Total |
| 3'X5'
|
Nylon |
___@$9.00 |
___@$3.00 |
___@$4.05 |
______ |
| 3'X5'
|
Cotton |
___@$9.25 |
___@$3.00 |
___@$4.05 |
______ |
| 4'X6' |
Nylon |
___@$13.50 |
___@$3.00 |
___@$4.05 |
______ |
| 5'X8' |
Nylon |
___@$18.00 |
___@$3.00 |
___@$4.05 |
______ |
| 5'X8' |
Cotton |
___@$20.00 |
___@$4.00 |
___@$4.05 |
______ |
| |
|
|
|
Total:
|
______ |
*Please
Note - If you want the flag flown over the Capitol, you must include
the entire Flying/Certification fee.
Check or
money orders should be made payable to: "Tom Davis Stationary
Account". Do not send cash and please send exact amount.
Flag requests must be received at least two weeks prior to the flying
date. After the request is received, allow five to seven weeks for processing
and delivery. If you have any further questions, please contact Lauren DeWolfe at (202) 225-1492.
| Please
send check or money order to: |
Representative
Thomas M. Davis III
2348 Rayburn House Office Building
Washington, DC 20515-4611
Attn: Flag Coordinator
|
|