Please write 3-5 sentences explaining your request for a Village flag and supply the name, address and other information about the person(s) who would receive the flag below.*

Name:*

Address:*

Address Line 2:

City:*

Contact Phone Number:*

Email Address (if known):

Please fill out contact information for the person submitting this request below.

Name:*

Contact Phone Number:*

Email Address:

By Clicking “I agree,” you agree and acknowledge that 1) your application will not be "Signed" in the sense of a traditional paper document and 2) By signing in this alternate manner, you agree that your “electronic signature” is valid and binding upon you to the same force and effect as a handwritten signature.
*

I agree