FLAG ORDER FORM

Date:  
Name:  
Address:

 
Phone:  
Please mail flag to (if different from name and address above):  
Name:  
Address:

 
Please Select Your Choice(s) Below:  
3 ft. x 5 ft. Cotton - $17.85 Number of flags: Total Cost:$
3 ft. x 5 ft. Nylon - $16.90 Number of flags: Total Cost:$
4 ft. x 6 ft. Nylon - $22.10 Number of flags: Total Cost:$
5 ft. x 8 ft. Cotton - $30.10 Number of flags: Total Cost:$
5 ft. x 8 ft. Nylon - $26.60 Number of flags: Total Cost:$
Name or information to be included on accompanying certificate:  
 

  
Please fly on (date):


Please complete and print this form and return it to:
Congressman Pete Hoekstra
184 South River Avenue Holland, MI 49423

Please include with your order form a check payable to:
Congressman Pete Hoekstra Office Supply Account

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