Ida Cooper Elliott

FranklinCounty Supervisor of Elections

Order Form and Fee Schedule

47 Ave F, Apalachicola, FL32320

Phone: 850-653-9520 / Fax: 850-653-9092

Name of Requester: ______Date: ______

Phone: ______Fax: ______

Email: ______

Name of person picking up order (if other than self): ______

  • Only the requester or the person listed above may pick up the data.

To Order: Mark clearly how you would like your data. Each selection must by complete for your order to be processed. If this form is not complete it may delay your order. Your

request will not be made available to you until payment is received.

Fee Schedule for available data:

  • Printed List: (less than 5000 names) $15.00 (more than 5000 names) $25.00
  • Mailing/Absentee Labels: 3 cents per label, with $10.00 minimum
  • CD or Email: $15.00 ( District or CountyWide)
  • Absentee Request Information: $25.00 (one time charge) CountyWide, $15.00 (one time charge) Districts
  • Consists of initial Absentee List and covers continuous updates throughout the election cycle.

If you need the data mailed to you in hard copy please specify a mailing address:

______

______

Data will not be mailed until payment is received.

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You will be called or emailed at the above listed contact information when your order is ready. Balance owed is due upon release of order. Allow 1-2 business days for most orders. All orders must be placed on this form and can be emailed or faxed in. In some situations phone orders will be accepted.

NOTE: THE DATA YOU ARE PURCHASING IS FURNISHED BY THE REGISTERED ELECTORS OF FRANKLINCOUNTY AND IS ONLY AS CURRENT AND ACCURATE AS THE INFORMATION THE ELECTOR HAS PROVIDED THIS OFFICE WITH.

Order Form Below:

  1. Output Option: ______Printed List

______Mailing Labels (Mailing Address Only)

______Absentee Labels

______CD

______Email / Email to ______@______

  1. Order of Voters:

______Name

______Name by Precinct

______Residence Address

______Residence Address by Precinct

______Zip

______Household (mailing labels, CD, and email only)

  1. Party Selection:

______All Parties

______Democrat

______Republican

______Other (please specify) ______

  1. Specify District or Precint:

______All of FranklinCounty

______City (please specify) ______

______Congress

______Senate

______State Representative (please specify) 6th or 10th

______Precinct (please specify) ______

______District (please specify) ______

  1. Address Selection :

______Residence Address

______Mailing Address

______Both Residence and Mailing Address (not available on mailing labels)

  1. Voter History: (If you want history you must be specific about which election you want) Example: 2000 General

Do not put 2000 and 2004. Do not put all elections because there is a limit of

20 elections.

______Yes, I only want the people that voted in the elections listed below.

Specify Election (s): ______

______Yes, I want everyone that is registered to vote with voter history (Can only be requested on CD)

Specify Election (s): ______

______No, I do not want voter history

For Office Use Only:

______Printed List

______Mailing Labels

______CD/ Email

______Absentee

Total: ______

Paid with: ______