Bollard Maintenance Request Form
Please provide details about the bollard needing maintenance so our team can assist you efficiently.
Your Full Name
*
First Name
Last Name
Your Email Address
*
example@example.com
Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Location of Bollard (Street address, intersection, or landmark)
*
Bollard Identification Number (if available)
Type of Issue
*
Damaged
Loose
Missing
Obstructed
Needs Cleaning
Other (please specify)
Please describe the issue in detail
*
When was the issue first noticed?
-
Month
-
Day
Year
Date
Urgency Level
*
Please Select
Routine (no immediate hazard)
Moderate (potential hazard)
High (immediate hazard to public safety)
Upload a photo of the bollard or issue (optional)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Submit Request
Should be Empty: