Flag Request

Qty.	Size	Material	Price	Flown over Capitol	Sub-total
	3' x 5'	Cotton	$9.25	Yes ($4.05 per flag)
	3' x 5'	Nylon	$9.00	Yes ($4.05 per flag)
	5' x 8'	Cotton	$20.00	Yes ($4.05 per flag)
	5' x 8'	Nylon	$18.00	Yes ($4.05 per flag)
Shipping & Handling ($4.00 per flag)			$0.00
Total:					$0

Requester's Information

First Name *

Last Name *

Phone *

Email *

Verify Email *

Street Address *

Street Address 2

City *

State *

Zip *

Shipping Address

Shipping address is the same as requestor's address

Street Address *

Street Address 2

City *

State *

Zip *

In Honor Of...

If you are requesting that this flag be flown in someone's honor or memory, you may enter that information in the section below.

Salutation *

First Name *

Last Name *

Occasion

To Be Flown On Any Date
Specific Date

Select Date

Special Instructions

Please Mail Form, with Payment, to:

Flag Request
c/o U.S. Senator Jeff Merkley
107 Russell Senate Office Building
Washington, D.C. 20510

Mail Delay

Please note that due to heightened security in the U.S. Capitol, mail service to my Washington, D.C. Senate office is significantly delayed. If you have any correspondence that is time sensitive, please use alternatives such as e-mail, phone, or fax.