Designated State Agency Order Form

Agency and Contact Information

Agency Name *

First Name *

Last Name *

Phone Number *

Extension

Email *

Confirm Email *

Shipping Address

Address Line 1 - we cannot ship to P.O. Boxes *

Address Line 2

City *

State *

Zip *

Voter Registration Applications

****Applications are shipped in packs of 100, so please enter your order accordingly (100, 200, etc.)****

Please allow 7 to 10 days for your materials to arrive. We appreciate your patience and understanding.

If you have an immediate need for applications, feel free to print them off our website:

https://www.elections.virginia.gov/registration/how-to-register/

ENGLISH - VA Voter Registration Application (VA-NVRA-1 7/24)

SPANISH - VA Voter Registration Application (VA-NVRA-1 7/24)

KOREAN - VA Voter Registration Application (VA-NVRA-1 7/24)

VIETNAMESE - VA Voter Registration Application (VA-NVRA-1 7/24)

Transmittal Envelopes

I am requesting 26 of the following transmittal envelopes for Voter Registration Applications:
(you may only select one of the following based on your agency)

A Envelopes (Public Assistance Agencies: VDH, DSS, DBHDS, CSBs)

C Envelopes (Disability Agencies: DARS, VDDHH, DBVI, Higher Ed Disability Offices)

D Envelopes (Discretionary Agencies: DGIF, VEC, Northern Virginia Planning District 8)-

M Envelopes (Military Recruiting Offices)

Please allow 7 to 10 days for your materials to arrive. We appreciate your patience and understanding.

Contact Information - ELECT

For shipping issues please contact ea@elections.virginia.gov