E-Gov Services Midland

Street Light Repair Request

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Purpose. Use this form to report a street light that needs repair. Note:This form is for lights along side public streets. Do not use this form for traffic signals

* Information is required.

Contact Information

* First Name:
* Last Name:
* Email:
* Daytime Phone:	() –
Address:
City:
State:
ZIP:

* Please identify the street light concern.

Light does not turn on

Light is on during the daytime

Light turns on and off through the night

Light pole is down

Light is dim when it is lit

Other

Please provide a detailed description of your concern to help identify the problem:

Enter the specific location of the street light (street name, near XXXX address, etc)

Check here to have email confirmation of this request sent.

* Information is required.

Notes:

When you submit information through this form, you will receive a Tracking Number. You can track the status of your request by entering your tracking number in the field provided on the "Services and Information Requests" page.

Internal Use Only, Leave Blank:
Please leave this field blank and remove any values that have been populated for it.