E-Gov Services City of Papillion

City Services Comments

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Purpose. This form is used to communicate with city personnel to evaluate city services, staff and contractors.

* Information is required.

Contact Information

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

Issue/Problem Location:

* Address:	- Or Other Not Listed -
Unit:

	Provide any additional information on problem location in the box below.

Please describe your satisfaction or concern with City services in this section.

Please describe the event, service performed and your satisfaction or concern with the service.

Please supply any other information that would assist us in resolving the matter. Include date, time, location or other specifics.

Check here to have email confirmation of this request sent.

* Information is required.

Notes:

If you send us a message, you'll receive a Tracking Number allowing you to follow-up with your request, at your convenience.

Information we receive may be considered public information which is subject to disclosure under current state law. Learn more about our Privacy Policy.

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