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2. Name*
   Name as it is to appear on Certificate of Purchase.
3. Email Address
5. Contact Name*
7. Mailing Address*
9. City*
10. State*
11. Zip Code*
13. Phone Number*
14. Fax Number
16. 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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18. 1. Receive an email copy of this form.
19. Email address

    This field is not part of the form submission.

20. Submit Submit and Print

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