Service Request

Service Request

Reporting Party Information:

*First Name:     *Last Name:

*Email:

Phone Number:    Ext.

 

*Type of Service Request (select one)

 

*Location of Service Request:

Address:

Cross Streets:

Additional Info:

 

*Description of Service Requested:

(Please note, light poles may be SCE, HOA, or City owned, therefore, include pole number)

Fields with (*) are required.

 

 



Security Measure