The Hamilton County Election Commission

Voter List Purchase Form

Submit online below OR mail/email this completed form to:

Hamilton County Election Commission
700 River Terminal Road, Chattanooga, TN 37406
Email: [email protected]

Requestor Information

Requestor's Name or Name of Agency/Group: *

Requestor's Address (Street, City, State, and Zip Code): *

Requestor's Phone Number: *

Email Address: *

Is Requestor a TN Resident? *

Yes No

Order Details & Certifications

Political Purposes Certification: *

I certify that the voter information I am purchasing with this order is for political purposes. I DO NOT certify that the voter information I am purchasing with this order is for political purposes.

Type of Request: * Electronic voter list - $42.00

Description of Voter List Requested: *

By signing and submitting this data order form, you understand that THERE ARE NO WARRANTIES. This means the Election Commission will not be responsible for any costs, including but not limited to those incurred as a result of lost profits or revenue, loss of use of the software, loss of data, the cost of recovering such data, or the cost of substitute software of claims by third parties. In no case shall the Election Commission liability exceed the amount of the purchase fee. Providing your own technical support is in the terms of this purchase. The Hamilton County Election Office will not provide technical computer support. You agree to pay the total amount due before this order is fulfilled and transmitted to you.

Your full name below, if typed, is your electronic signature and is the legal equivalent of your written signature on this form.

Signature of Requestor

Date