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Complete the form below to schedule your Ballot Will Call pick-up. If you provide an email, our office will notify you when the ballot is ready for pickup.

1. Name

2. Date of Birth (*REQUIRED)

(eg. 01/31/1900)

3. Residence Address

(Where you live)

4. Email Address

5. Phone Number

6. Permanent Vote by Mail

I am requesting to become a permanent Vote by Mail Voter. A Vote by Mail ballot will automatically be sent to me in all future elections. I understand that if I fail to Vote by Mail in four (4) consecutive statewide general elections, I will need to reapply for permanent Vote by Mail status.


7. Terms

I have not applied for, nor do I intend to apply for, a vote by mail ballot from any other jurisdiction for this election. By submitting this application, I certify under the laws of the State of California that the name and residence address and information I have provided on this application are true and correct.

Only the registered voter himself or herself may apply for a vote by mail ballot. An application for a vote by mail ballot made by a person other than the registered voter is a criminal offense.

A BALLOT WILL NOT BE SCHEDULED FOR PICK-UP IF THIS APPLICATION IS INCOMPLETE OR INACCURATE.