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DPW Service Request
Service Request Form
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Please complete the form below to submit your request to the Bolton DPW.
Choose from the following:
Checkboxes
Checkbox Description
Checkboxes
Checkbox Description
(SA01) Traffic Sign Request
(SA10) Pot Hole Repair Request
(SA02) Street Sign Request
(SA12) Sidewalk Repair Request
(SA03) Crosswalk Painting Request
(SA19) Plowing Complaint
(SA06) Tree Cutting/Trimming Request
(SA14) Illegal Dumping Pickup Request
(SA07) Street Light Out Notification
(SA20) Other
(SA08) Trash/Recycling Issues
Please provide the following information:
Field Description
Field Data
Required Field
Name:
required
Email:
required
Address:
required
Phone:
Cell Phone:
Date:
required
Time:
required
Request Location:
required
Please give a brief description of your work order request:
Field Description
Field Data
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