First Name

Last Name

Telephone Number

-

Email Address

Location of Traffic Signal

Cross Street Name

Choose One or More Options

Flashing Red

Signal Head Turned/Knocked Down(Indicate corner and Direction)

Signal Head Burn Out (Indicate Red/Amber/Green and Direction)

Does Not Cycle (Indicate Direction)

Pedestrian Push Button Out (Indicate Direction and Pole Location)

Pedestrian Signal Burn Out (Indicate Direction and Pole Location)

Other (Please Describe Below)

Request Details