Street Light Repair Request Form

Location of Street Light

* Street Light Pole Number:*
(Enter "unknown" for no pole number.)   (Pole number is located 6 to 10 feet up from bottom of the pole. This is the best method to identify the 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

If we need to follow-up with you, please provide your contact information:

Before you submit this form, please be aware of the city's policy on use of its systems. The message you are about to send is subject to public disclosure under the Public Records Law. It is not private or confidential and is retained for 90 days.