Prescribed by Secretary of State
Section 51.013, Texas Election Code
Name of company:
Mailing address:
City, State, Zip:
County in which business is located:
Date of registration:
Name of company contact
Telephone number of company contact: ( )
Names and telephone numbers of sales representatives:
(If you have more than four sales representatives, attach additional list of sales representatives.)
Type(s) of materials you will print (check as many as appropriate):
1. Paper ballots
2. Optical scan ballots
3. Election supply kits
4. Other (brief description including Ballot
Now, Ballot on Demand, Programming
of DRE’s)
Signature of Company Contact
See reverse side for instructions. See next page for registration of customers.
Give the name of the person who is actually in charge of the printing of ballots or the forms, and who will serve as the contact
person between the printing company and the Secretary of State.
Page ___________ of ___________
Name of printing company: _______________________________________________________
Date: ________________________________________________________________________
(check one.)
Original registration for customer
Supplemental registration for customer
Name of customer (political subdivision) you sell to (include separate registration page for each customer
i.e., county Democratic party, county Republican party, or the county):
Identify county (and party):
Name of customer contact:
Type of election: Primary Runoff General
Type of printing (check as appropriate)
A. BALLOTS (check appropriate type of ballot):
1. Paper ballots 2. Optical scan ballots 3. Other: Ballot Now, Ballot
on Demand, Programming
of DRE’s
C. OTHER (brief description):
If any information should change or additional services are provided after the original registration has been filed for a
particular customer, indicate that this is a supplemental registration.
If you are registering for a primary election, and the services will be different between the first primary and the runoff,
indicate the election at which the service will be provided. For example, you may be printing Optical Scan Ballots for the first
primary and paper ballots for the runoff election. You will check both numbers 1 and 2 and indicate to which election each
DO NOT register with the Secretary of State if you only print ballots for city, school, or other types of
elections other than the primary elections or November general elections for state and county officers.
REGISTRATION IS NOT FOR A BID LIST. The name of the printing company will be filed and
information regarding the printing for the primary or general election will be mailed to you, as necessary.
The Texas Election Code requires you to register your printing company with the Secretary of State at
least 60 days before each election at which you will be printing ballots or forms for the primary and/or
general election for state and county officers.
If you do not have any contracts to print ballots or forms 60 days before the Republican or Democratic
party in a primary election or for a county in the November general election, you may register with the
Secretary of State without any customers. Once you secure a contract or order, you must immediately
notify the Secretary of State of the name of the customer and the type of work you will be doing for that
If you have your customer list on a computer, you may submit a computer printout in lieu of this form, as
long as the printout contains the required information.
Mail registration forms to Secretary of State, Elections Division, P.O. Box 12060, Austin, TX 78711.