Flag Request

Flag Request Order - Congresswoman Nan Hayworth

If you would like to have a flag flown above the Capitol Building, you may order one from my office. A certificate is printed by the Architect of the Capitol for every flag that is flown, so if it is being flown in honor of a special occasion you may include an excerpt that you would like the certificate to read. In addition, you may request a specific day on which you would like the flag to be flown.

Please note: We can only process flag requests from constituents in New York's Nineteenth District or requests being sent to a constituent in the nineteenth district. If you are not in New York's Nineteenth District please contact your congressional representative to order a flag.

* indicates required information.

Your Information

Prefix: Select One Mr. Mrs. Miss. Ms. Dr.

First Name:*

Middle Initial:

Last Name:*

Suffix:

Street address:*

Address, line 2:

City:*

State:* Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York North Carolina Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming

ZIP:* -

Phone number: (for questions regarding your order)

E-mail Address:*

Click the following checkbox to copy the purchaser's information into the fields below.

Shipping Address

The next address is where the order will be sent. This information must be filled in.

Prefix: Select One Mr. Mrs. Miss. Ms. Dr.

First Name:*

Middle Initial:

Last Name:*

Suffix:

Street address:*

Address, line 2:

City:*

State:* Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York North Carolina Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming

ZIP*: -

Phone number (for questions regarding delivery problems)

Number of Flags

You can enter up to 10 items in each box.

If you choose to have your flag flown over the United States Capitol, please complete the following information for the certificate. If your names and/or occasions to appear on each certificate, please leave the name and occasion information below blank, please use separate forms per each flag.

If you would like your flag to be flown on a particular day, enter that day here:

Requests cannot be processed more than one month prior to the date the flag would be flown.

The following information will be included on the Congressional Flag Certificate

Dedication Message

Special Instructions for the Flag Coordinator:

Please submit your request at least five weeks ahead of your desired date. Your order will be shipped using the U.S. Postal Service.

Please make checks payable to "Hayworth Office Supply Account" and mail to:

Congresswoman Nan Hayworth
1440 Longworth House Office Building
Washington, DC 20515