Voter Fraud Report Form

Please provide as much information as possible.

Your Name*

First Name

Middle Name (optional)

Last Name

Your Phone*

What's the best phone number to reach you at?

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Your Email

Confirm Your Email*

What's the best email address to reach you at?

State of the Incident*

Which state did this incident occur in?

County of the Incident*

What's the county where the incident occurred?

Name of the Polling Place or Early Voting Site

What's the name of the polling place where the incident occurred?

Description of the Incident*

Please describe what's occurred or occurring

Photo of the Incident No File Chosen

File uploads may not work on some mobile devices.

Files accepted include: jpg,jpeg,gif,png,pdf

GCLID (Google Click Identifier)

This hidden field has been added by Attribution to CRM Plugin to store GCLID (Google Click Identifier) in this Form's submission table

Campaign Name

This hidden field has been added by Attribution to CRM Plugin to store Campaign Name in this Form's submission table

Campaign Content

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Campaign Term

This hidden field has been added by Attribution to CRM Plugin to store Campaign Term in this Form's submission table

Campaign Medium

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Campaign Source

This hidden field has been added by Attribution to CRM Plugin to store Campaign Source in this Form's submission table

Voter Fraud Issue Report Form