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Use this form to report a pothole.

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Location of pothole.
(be as specific as possible)*

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Size of pothole*

Small (less than 12 inches across) Medium (12-24 inches across)

Large (over 24 inches across)

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Special Circumstances

Is creating a traffic hazard

On major street

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Your Information

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Name:

Business Name:

Street Number and Name:

Address Line 2:

City:

State:

Zip Code:

Phone Number:

Fax Number:

Email Address:

Preferred Contact Method:*

Do NOT contact me Email

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