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Welcome to the Village of Antioch, IL, Action Line
Today is Monday, December 5, 2022.
Mailbox Damage Reimbursement Form

Purpose. It is the policy of the Village of Antioch to reimburse residents up to $75.00 for eligible damage to mailboxes from direct plow contact. Use this form to submit your request. Each submittal must be accompanied by a receipt and other other evidence supporting your claim (i.e. photos or any other evidence that you feel proves the Village is responsible for the damage). If there is a police report, please attach (not required).

* Information is required.

Contact Information

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

* Date of Mailbox Damage
 
* Approximate Time of Mailbox Damage
 
If there were witness(es) to the mailbox damage, please list their names & phone numbers.
 
Damage is to:



4
 
Please provide a description of the mailbox damage:
 
Attach a Picture or File (max size: 30MB):
Add Another FIle

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* Information is required.

Notes:

If you send us a message, you will receive a Tracking Number allowing you to follow-up with your request, at your convenience. Responses may be delayed dependent on staffing. If this is an urgent matter, please call Village offices at 847-395-1000.

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