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Electric Department Job Request Form
Requests for the Electric Department to perform general maintenance can be made by completing the following information.
Choose from the following:
Checkboxes
Checkbox Description
Checkboxes
Checkbox Description
Street Light Out
Broken / Damaged Utility Pole
Flickering Lights
Low Voltage
Rental Light Out
Tree Limb on Utility Line
All Other Electric Problems (Please Describe Below)
Please provide the following information:
Field Description
Field Data
Required Field
Name:
required
Email:
required
Address:
required
City:
required
State:
Zip:
Phone:
required
Alt Phone:
Fax:
Organization:
Location of job request, if different from address.
Description of job that needs completing.
Additional Comments.
City of Highland Illinois, 1115 Broadway, P.O. Box 218, Highland IL 62249-0218 | 618-654-9891 |
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