Rural Area Lighting Maintenance Request Form
Submit this form to report and request maintenance for rural area lighting issues. Please provide accurate details to help us address the problem efficiently.
Your Full Name
*
First Name
Last Name
Contact Email
*
example@example.com
Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Location of Lighting Issue (address or nearest landmark)
*
Type of Lighting
*
Please Select
Streetlight
Floodlight
Yard Light
Other
Nature of the Issue
*
Light not working
Light flickering
Light stays on
Damaged fixture
Exposed wiring
Other
Describe the Issue in Detail
*
Is this issue hazardous (e.g., exposed wires, risk of injury)?
*
Yes
No
Not sure
Urgency Level
*
Please Select
Routine
Urgent
Emergency
Upload a Photo (optional)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Submit Request
Should be Empty: