2. Use this form to request or report the following: repair of street or potholes, street drainage problems, street sign issues,streetlight outage (provide streetlight pole number). Your name, telephone number, and e-mail address are not required, but are helpful should questions arise.
4. Reported location must be within the Town of Wilson Boundaries. The exact reported location/site address is required
6. Please use one form per request!
10. Contact Information
12. First Name
13. Last Name
15. Phone Number
16. Email Address
18. Street Address:
20. Exact Location of Job Requested
22. Street Name, Address or Block Number*
24. Nearest Two Cross Streets
26. Nature of Request*
Leave This Blank:


28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit Submit and Print

* indicates a required field