FLAG REQUEST FORM

NAME: 
PHONE NUMBER:
ADDRESS: 


NAME/ADDRESS WHERE FLAG SHOULD BE SENT:


FLAG FLOWN IN HONOR OF:

ON THE OCCASION OF:

DATE FLAG TO BE FLOWN (If Applicable):

FLAGS FLOWN OVER THE CAPITOL

QUANTITY		FLAG TYPE/SIZE			PRICE
__________ 		3'X 5' Cotton			$ 18.60
__________		3'X 5' Nylon			$ 17.65
__________		4'X 6' Nylon			$ 22.85
__________		5'X 8' Cotton			$ 30.45
__________		5'X 8' Nylon			$ 27.35

FLAGS NOT FLOWN OVER THE CAPITOL (ALSO AVAILABLE AT DISTRICT OFFICES)

QUANTITY		FLAG TYPE/SIZE			PRICE
__________		3'X 5' Cotton			$ 14.55
__________		3'X 5' Nylon			$ 13.60
__________		4'X 6' Nylon			$ 18.80
__________		5'X 8' Cotton			$ 26.40
__________		5'X 8' Nylon			$ 23.30

PLEASE PRINT THIS FORM, FILL IT OUT, AND MAIL IT, ALONG WITH YOUR CHECK 
OR MONEY ORDER MADE OUT TO THE JOHN D. DINGELL STATIONARY ACCOUNT TO ONE 
OF THE FOLLOWING DISTRICT OFFICES:

CONGRESSMAN JOHN D. DINGELL	CONGRESSMAN JOHN D. DINGELL
19855 WEST OUTER DRIVE		23 EAST FRONT STREET,
SUITE 103E				SUITE 103
DEARBORN, MI  48124			MONROE, MI 48161

CONGRESSMAN JOHN D. DINGELL
301 W. Michigan Ave.
Suite 305	
Ypsilanti, MI 48197