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Flag Lease Program - Online Enrollment

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Online Flag Lease Application

 

 

  
Only letters are allowed
First name is required
Minimum characters = 2
Only letters are allowed
Last Name is required
Minimum characters = 3
Only letters are allowed
Sub-division name is required
Minimum characters = 8
Special characters not allowed
Street address is required
Minimum characters = 8
Only letters are allowed
City is required
Minimum characters = 3
Only letters are allowed
State is required
Please use 2 character state abbreviation
Zipcode must be numeric
Zipcode is required
Zipcode should be 5 digits
Home phone is required
Home phone must be 14 characters long
Mobile phone is required
Mobile phone must be 14 characters long
Email address is required
Email address format is invalid

Gift Recipient Information

Only letters are allowed
First name is required
Minimum characters = 2
Only letters are allowed
Last name is required
Minimum characters = 3
Only letters are allowed
Sub-division name is required
Minimum characters = 8
Special characters not allowed
Street address is required
Minimum characters = 8