Absentee Ballot Request
You must be registered to vote before you submit your Absentee Ballot Request.
To check if you are a registered voter:
go to State Voting Requirements / “State Lookup Tools” for a link to your state’s voter registration lookup tool.
Name
Title
Mr.
Mrs.
Miss
Ms.
First *
Middle
Last *
Suffix
Jr
Sr
II
III
IV
Contact Information
Primary Email *
(used for login if applicable)
Please Confirm Your Email *
Phone * (select country flag first)
Phone Type *
Home
Work
Mobile
Other
Previous Name
(Use this option if you want to update your name)
Title
Mr.
Mrs.
Miss
Ms.
First
Middle
Last
Suffix
Jr
Sr
II
III
IV
Alternate Contact Information
Alternate Email
Alternate Phone
(work phone, cell phone)
Phone Type
Home
Work
Mobile
Other
Birth Date
Month *
Select
1
2
3
4
5
6
7
8
9
10
11
12
Day *
Select
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year *
Select
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
1919
1918
1917
1916
1915
1914
1913
1912
1911
1910
1909
1908
1907
1906
1905
1904
1903
1902
1901
1900
Personal Details
Sex *
Select
Male
Female
Home Address
Where you are registering to vote
Your legal address used for voting purposes
Use Rural Route
Use Address Description
Address 1 *
(Cannot be a P.O. Box)
Address Description *
Address 2
(Apt, Suite, Building, Floor, etc.)
City/Town *
County
State *
- Select -
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
ZIP Code *
ZIP+4
Voting Region *
(Select state to see options)
- Select -
Ballot Mail-to Address
Enter address information ONLY if it is different from your Home Voting Address
Address 1
Address 2
(Apt, Suite, Building, Floor, etc.)
City/Town
County
State/Province/Region
Zip/Postal Code
Voters Alert / Mailing List Opt-In
Stay Informed of Upcoming Elections
Yes, I would like to receive Voter Alerts
x
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