Street Light Out Form

Requestor Information

If we can not locate the problem, we may attempt to contact you for additional details. Your personal information will be kept private and will never be used for any other purposes.
Name *
Phone Number *

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Email *

Street Light Information

This information is necessary in order to direct our electrical crew to the proper street light(s) in need of repair.
Pole Number
The pole number is usually located on the street facing side of the pole.
Light Location Address *
Cross Street
Additional Address Info
Please be descriptive (e.g. corner of College and Ash in front of the deli shop)
Condition of Light *
 Out 
 Flickering 
 Stays On 
Is there damage to the light? *
 Yes 
 No 
If yes, please describe (e.g. the street light cover is broken)
Additional Information or Comments (e.g. there are 4 street lights out on this block)