Request Your Virginia Absentee Ballot | Secure Your Vote Virginia

Personal Information

Please fill out the information below:

First Name

Last Name

Phone Number

Email Address

Registration Address

Please input the address that you are registered to vote at:

Address*

Apt/Suite

City*

Zip Code

Locality*

NOTE: Your locality is the city or county in which you reside, it is NOT Virginia.

Mail my ballot to the above address.

I have a different mailing address.

Mailing Address

Please input the address for where your absentee ballot should be mailed:

Address*

Apt/Suite

City*

State*

Zip Code

Secure Information

Your personal information will be sent to your County Registrar only and will not be stored.

Last 4 of Social Security #*

0 of 4 max characters

* The last 4 digits of your SSN are required to request your absentee ballot via this online portal.

Birth Year (optional)

Election Information

Please confirm the following statements by checking each box:

Do you want to vote by mail for all future elections?

Yes

If yes, which party primary ballots would you like to receive? You may select one party designation under Virginia law.

Republican Party

Democratic Party

I do not wish to receive ballots for Primary Elections.

Please check ALL that apply:

I am requesting a ballot for the November 2023 General Election in Virginia

I do NOT need assistance filling out this request form due to a disability, blindness, or an inability to read or write.

I am NOT a Military or Overseas voter.

I consent to use an E-Signature as my signature mark to request my ballot

*If you are not able to confirm all of these statements, please click here.

Confirm Your Information and E-Signature

Please confirm the following information:

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Voter’s Statement + Signature

I swear/affirm, subject to felony penalties for making false statements pursuant to VA Code § 24.2-1016, that (1) the information provided in this form is true, (2) I am not requesting a ballot or voting in any other jurisdictions in the US, and (3) I am registered to vote in the city/county where I am applying to vote.

Draw your signature in the box below:

Click the button below to send your vote by mail application to your registrar’s office:

REQUEST YOUR ABSENTEE BALLOT