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Citizen Request for Services Form
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Please use this form to get in touch with us or report an issue such as pothole or street light outtage! We appreciate your feedback. Please do not use this online form for police matters or an emergency. In an emergency, dial 911.
Reported location must be within the Easttown Township. Please be as specific as possible regarding the location or nature of request.
Contact Information
First Name
*
Last Name
*
Phone Number
Email Address
*
Street Address:
Exact Location of Job Requested
Street Name, Address or Block Number
*
Nearest Two Cross Streets
Nature of Request
*
Department
*
Please select a department for the request
Public Works
Building
Administration
Other
Please Explain Other Department
*
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