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2. Elections Data Request Form
   Submit the following form to process your order. Failing to complete the information below could delay your order. Completed data orders are not refundable.
4. First Name*
5. Last Name*
7. Campaign or Organization
   (if applicable)
9. Phone Number*
11. Your Email Address*
13. Type of Data Requested:*

    1. Daily Email - Ballot Status File
    2. Jefferson County Voter File
15. Signature of Applicant*
    The typed signature in this field indicates this individual accepts responsibility for the accuracy of the information provided within this form.
Leave This Blank:


17. 1. Receive an email copy of this form.
18. Email address

    This field is not part of the form submission.

19. Submit

* indicates a required field