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2. Name*
   Name as it is to appear on Certificate of Purchase.
3. Email Address
5. Contact Name*
6. 
8. Mailing Address*
10. City*
11. State*
12. Zip Code*
14. Phone Number*
15. Fax Number
17. Tax Payer ID Number
    Please contact our Graham County Treasurer's Office at 928-428-3440 with your Tax Payer ID Number. For security reasons we will not collect this information online. Thank you!
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19. 1. Receive an email copy of this form.
20. Email address

    This field is not part of the form submission.

21. Submit Submit and Print

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