Form Center

Citizen Request for Services Form

2. Use this form to request or report the following: repair of street or potholes, reporting of hazardous sidewalk condition, street or gutter drainage problems, bike paths and catch basin stoppages, street sign issues, traffic signal outage, streetlight outage (provide streetlight pole number). Your name, telephone number, and e-mail address are not required, but are helpful should questions arise.

4. Reported location must be within the City of CivicPlus Boundaries. The exact reported location/site address is required

6. Please use one form per request!

10. Contact Information

12. First Name

13. Last Name

15. Phone Number

16. Email Address

18. Street Address:

20. Exact Location of Job Requested

22. Street Name, Address or Block Number*

24. Nearest Two Cross Streets

26. Nature of Request*

Leave This Blank:


28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit Submit and Print

* indicates a required field