Requestor's Name
Address
City		State	ZIP
Daytime Phone #		Fax Number
Email Address
Date flag is to be flown
Name(s) in whose honor the flag will be flown
Please indicate specific verbiage for the purpose of the flag being flown, to be included in the Certificate of Authenticity (such as retirement and years of service)
Delivery method	Contact me so that I may pick it up
	Mail it to me at the address above

Item	Quantity	Price	Total Cost
3' x 5' United States Flag (nylon)		$29.00	$
3' x 5' Colorado State Flag (nylon)		$28.00	$
		Total Amount Due:	$

Please note: Flags cannot be flown until payment is received. Instructions will print on your confirmation page.