Pottstown Service Requests

Date:

: 03:20 PM

Your Name:

(Required)

Your Address:

(Required)

City State Zip:

Phone Number:

(Required)

Email:

Check If Rental Rental Unit Number Tenant Owner

Location of Service Issue being Reported

(Required)

STREET LIGHT CONDITION

Light on in day time

Light Completely Out

Light goes On / Off

LOCATION OF LIGHT

	Full street address were light is located
Provide the closet address to were the street light is located.

	Intersection - Main Street Name
If Street Light is at an intersection-provide the name of  the main street

	Intersection - Side Street Name
If Street Light is at an intersection-provide the name of  side street

	North Side of Street
The  direction helps to further identify the defective light.

	South Side of Street
The  direction helps to further identify the defective light.

	East Site of Street
The  direction helps to further identify the defective light.

	West Side of Street
The  direction helps to further identify the defective light.

	Pole Number
Each street light pole usually has a plate identifying the pole. It is helpful for our electrician  to find the correct pole where the light is out faster if we have the pole number. If not, available this is not required.

Additional Details: 400/400

Upload Picture (JPG or JPEG ONLY)

Upload Picture (JPG or JPEG ONLY)