Service Request

* Required Field

Personal Information

Specify your name and contact information.

First Name

Last Name *

Address Line 1

Address Line 2

City

State/Province

Alaska

State/Province

ZIP/PC

Country

Day Phone

Evening Phone

Mobile Phone

Fax

Request Type *

-- Select One --

Request Type *

Description (NOTE: 254 character limit) *

Email Confirmation

Location

Location Options:

No Address Address Use Map

Location Description (NOTE: 300 character limit) *

Attachments:

If possible please attach unedited photo(s) of the issue being reported. Example: photos of a pothole, streetlight, street maintenance issue, or homeless camp are very helpful. Please limit attachments to one or two photos. For text only .doc and .pdf files accepted. Please keep all attachments to 4MB or less. Thank you!

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