X-Git-Url: http://git.hcoop.net/clinton/MarylandElectronicPetitionSignature.git/blobdiff_plain/b2d66a11628cfc1ab62e81c654f1a75101f3bb01..44f7b8483a13d74a8b77cc98099ffdd908371921:/enter_information.php diff --git a/enter_information.php b/enter_information.php dissimilarity index 71% index e6e7e76..7efb9f9 100644 --- a/enter_information.php +++ b/enter_information.php @@ -1,54 +1,169 @@ - - -
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Please enter your Name and ZIP Code as it appears on your Maryland Voter Registration

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First Name

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Last Name

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House Number

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ZIP Code

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E-Mail for Follow Up*

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First Name

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Last Name

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Date of Birth

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Phone Number**

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Phone Format

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443-123-4567

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Building Number

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House: 321 Here St.

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Use: 321

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Apartment: 21 Here St. Apt 1323

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Use: 21

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ZIP Code

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ZIP Code Format

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55555

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* E-Mail is not required, and will only be used with the petitioners to reach you. It will never be sold.
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** PHONE NUMBER IS REQUIRED BY STATE OF MARYLAND. WE WILL NEVER USE YOUR PHONE NUMBER - NEVER CALL - NEVER FOR TEXT MESSAGES.
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