E-Gov Services Village of Vernon Hills

Public Works - General Request or Question

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Purpose: This form is used to communicate with Village personnel to request services or information related to Public Works that is not listed under the Public Works categories.

* Information is required.

Contact Information

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

If applicable, location of request, comment, or concern:

If the address is the same as above, please reenter the address here.

* Address	- Or Other Not Listed - Invalid Address The address you entered does not match any in the system. You can select a valid address from the list, or if you are certain the address you entered is correct click the "Use the address I entered" button, to continue. The address you entered
Unit:
	Provide any additional information on the location in the box below.

* Add Question, Concern, or Request

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Notes:

Upon submitting a request, you will receive a tracking number which may be used to follow up with your request at a later date.

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