Street Light Repair Request

Location of Street Light

* Street Light Pole Number:*   (Pole number is located 6 to 10 feet up from bottom of the pole; best method to identify pole needing repair.)

* Closest Street Address Near the Pole:   (example: 4756 W. Polinta St.)

Additional Information Regarding this Repair Request.

*Is this a shield request?

Yes or No... Not a shield request Yes, this is a shield request

In the event we need to follow-up with you, please fill in as much of the following information as possible:

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