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 7/20)

SPANISH - VA Voter Registration Application (VA-NVRA-1 7/20)

KOREAN - VA Voter Registration Application (VA-NVRA-1 7/20)

VIETNAMESE - VA Voter Registration Application (VA-NVRA-1 7/20)

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.

Register to Vote Poster

Register to Vote Poster with fillable Time, Date, and Place.
(limit 15 per request)

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 Barbara Wilkins at barbara.wilkins@elections.virginia.gov.