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2. Request for Information
   • This form is required when requesting a list of registered voters – all requests must be made in writing.
   • The fee must be paid prior to the request being filled. We have 72 hrs. to complete your request.
   • * indicates a required field.
6. Name of Organization*
8. Purpose of Request*
10. Please Indicate how you would like to receive the information*

    1. Email
    2. Mail
    3. Pickup
12. Phone*
13. Fax
15. Email Address*
17. Mailing Address
19. City*
20. State*
21. Zip*
23. In what format would you like the information provided? Choose 1 or more.*

    1. Excel
    2. Text List
25. MARK ALL ITEMS TO BE INCLUDED ON LIST

    Note: Please complete a separate form for every list (1 form per list).

27. Voters residing in a specific District or Precinct?
29. Voters*

    1. All Active Voters
    2. Include Inactive Voters
31. Political Party*

    1. All
    2. Democrat
    3. Republican
    4. Unaffiliated
    5. Other
33. If 'Other' to Political Party, please specify.
35. Address*

    1. Residential Address
    2. Mailing Address
37. Misc

    1. Date Registered
    2. Affiliation Date
39. Sort Order*

    1. Alphabetical by Last Name
    2. By Precinct
43. Estimating fees: The cost is $25.00 or 1 cent per name, whichever is greater. The voter numbers change daily. Once this form is completed we will be able to quote a price for your list.
45. Signature*
46. Today's Date*
    Today's Date
Leave This Blank:


48. 1. Receive an email copy of this form.
49. Email address

    This field is not part of the form submission.

50. Submit

* indicates a required field