Street light pole number:

(Pole number is located 6-10 feet up from bottom of the pole; best method to identify pole needing repair.)

* Closest street address near the pole:

example: 9999 W. Idaho St.

* Closest cross streets near the pole:

example: Capitol And Idaho

Additional information about this repair request:

Additional Information

In case we need to follow up with you, please fill in the following information.

* Your Name (Last, First MI):

Your daytime phone number: