Congressman Thaddeus McCotter - Flag Request Form

I am glad to provide you with a flag flown over the U.S. Capitol.

If you are interested in requesting a flag please fill out the following information as completely as possible. You must fill out all sections marked with *. Someone will contact you to confirm your request when it is received in our office.

Due to the numerous requests received, my office is unable to provide these flags free of charge. We ask you to reimburse us for the cost of the flag and the charge for flying and mailing it.

* Name:

* Prefix	* First Name	MI	* Last Name	Suffix (Jr.,Sr.)

* Address:

Address Line 2:

* City:

* State: * Zip:

* Email:

* Phone:

* Choose a flag you want to order:

3x5 Nylon ($9.00)
3x5 Cotton ($9.25)
4x6 Nylon ($13.50)
5x8 Cotton ($20.00)
5x8 Nylon ($18.00)

* Would you like your flag to be flown over the Capitol?

If it is important for this flag to be flown on a particular day, enter that day here: (mm/dd/yy)

If it is important for you to receive this flag by a certain date, enter that date here: (mm/dd/yy)

The following information will be included on the Congressional Certificate:

* Occasion:

* Name:

Comments: