Streetlight Service Request Form
Report streetlight issues to help us maintain safe and well-lit streets. Please provide accurate details for a prompt response.
Your Full Name
*
First Name
Last Name
Your Email Address
*
example@example.com
Your Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Streetlight Location (Address or Description)
*
Nearest Landmark or Intersection
Pole Number (if visible)
Type of Issue
*
Please Select
Light is out
Light flickering
Light stays on during daytime
Light is dim
Broken fixture
Exposed wires
Other
Describe the Problem
*
How urgent is this issue?
*
Routine
Needs attention soon
Emergency (e.g., exposed wires, sparking)
Upload a Photo (optional)
Upload a File
Drag and drop files here
Choose a file
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of
Submit Request
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