2. Traffic Signal Repair Request
   A work order will be sent out for repair on the next business day and estimated time of completion is based on daily workload priorities and on a "first come-first worked" basis.
4. Contact Information
6. First Name
7. Last Name
9. Address1
11. Address2
13. City
14. State
15. Zip
17. Phone Number*
18. Email Address*
20. Traffic Signal Information
22. Request Applies to*

    1. Traffic Signal Out
    2. Traffic Signal Flickers On/Off
    3. Traffic Signal Does Not Change
    4. Other: (Be specific)
24. Location Address or Cross Streets and/or Pole Number*
25. Brief Description of Condition
Leave This Blank:


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

    This field is not part of the form submission.

29. Submit Submit and Print

* indicates a required field