Street Light Repair Request Form

    Location of Street Light:

    *Street Light Pole Number:   (Pole number is located 6 to 10 feet up from bottom of the pole; best method to identify pole needing repair.)

    *Closest Street Address Near the Pole:   (example: 4756 W. Polinta St.)

    *Please choose your Electric Service Provider*

    SRP    APS

    Additional Information Regarding this Repair Request.

*Is the shield missing on the light?

    In the event we need to follow-up with you, please fill in as much of the following information as possible:

    *First Name:   *Last Name:

    *Phone Number:  [example xxx-xxx-xxxx]

    Email Address:

* Required fields

Before you submit this e-mail form, you should be aware of the City's policy on the use of its e-mail systems. The policy states that the e-mail message you are about to send: (1) is subject to public disclosure under the Public Records Law, (2) is not private or confidential and (3) is retained for one month.