Street Light Service Request

Be sure to submit the form by pressing the "Send Service Request" button at the bottom of this form when you have completed filling out the form

* Indicates required fields

Name:

  *First:   *Last:

*Day Phone:

Other Phone:

*E-mail:

Fax:

 

*What is the problem with the street light?:

Where is the street light located? (Street Number, Name, Nearest Cross Street)

*Street Number and Name:

*Crossing Street:

We need the Number off the pole. This number should be on the street side of the pole located 5-6 feet from the ground. Having the number assures we repair the correct light, thereby reducing the cost of the repair. Without the number the time required to complete the repair will be much longer. If you've checked and there is no number enter "None".

*Number on the pole ##### :

What type of pole is it?

 

Notes:

Questions:

Comments: