Purpose. Use this form to report a street light that needs repair. Note: This form is for lights along side public streets. Do not use this form for traffic signals

First Name:*

Last Name:*

Email:*

Daytime Phone:*

Street:

City:

State:

ZIP

Please identify the street light concern.

Light does not turn on Light is on during the daytime Light turns on and off through the night

Light pole is down Light is dim when it is lit Other

Please provide a detailed description of your concern to help identify the problem:

Enter the specific location of the street light (street name, near XXXX address, etc)