Representative Fred Upton (MI-06)

Name:
Street Address:
Daytime Phone Number:
Email Address:
Please mail flag to (if different from name and address above):
Name:
Street Address:
Please Select Your Choice Below:

Please send payment in form of a check or money order made out to: Fred Upton's Office Supply Account 157 Kalamazoo Mall, Suite 180 Kalamazoo, Michigan 49007 --or-- Fred Upton's Office Supply Account 800 Centre, Suite 106 800 Ship Street Saint Joseph, Michigan 49085 Once we receive your order online we will begin to process your order, however, the flag/flags will not be shipped until payment has been received.
Flown over the Capitol	Not Flown over the Capitol
3 ft. x 5 ft. Cotton - $13.30	3 ft. x 5 ft. Cotton - $9.25
3 ft. x 5 ft. Nylon - $13.05	3 ft. x 5 ft. Nylon - $9.00
4 ft. x 6 ft. Nylon - $17.55	4 ft. x 6 ft. Nylon - $13.50
5 ft. x 8 ft. Cotton - $24.05	5 ft. x 8 ft. Cotton - $20.00
5 ft. x 8 ft. Nylon - $22.05	5 ft. x 8 ft. Nylon - $18.00

If Flag is to be Flown over the Capitol (choose one for the certificate):

A) Flown for

B) Present to

C) In Recognition of

D) In Memory of

E) To Commemorate

If applicable, flown for who or for what occasion:

If Flag is to be Flown on a specific date:

Please fly on: