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2. The City of White Settlement wants to hear from you! From general comments to specific concerns, this is a great way to get in touch with us and let us know how we can serve you.

4. Contact Information

6. First Name*

7. Last Name*

9. Address1*

11. Address2

13. City*

14. State*

15. Zip*

17. Phone Number*

18. Email Address*

20. If you're reporting a specific issue, please indicate the nature of your problem by checking the appropriate box(es) below:
    For general comments, please use "General Comments" field at bottom of form.

    For general comments, please use "General Comments" field at bottom of form.

22. 1. Pothole
    2. Damaged curb
    3. General road issues
    4. Traffic signals
    5. Traffic/Road signs
    6. Grass/Weeds
    7. Dogs barking
    8. General animal issues

    1. Code issues
    2. Unsafe driving
    3. Water bill issues
    4. Trash/bulk trash issues
    5. Parks issues
    6. Blocked drainage channel
    7. Stormwater Pollution

    1. Street Lights
    2. Damaged sidewalk
    3. Nuisance issues (noise, etc.)
    4. Storm sewer leaking/blockage
    5. Water leaking on road
    6. Manhole cover issue
    7. Crime/safety issues
24. Brief Description (or other problem not listed)

26. Location of Problem

28. General Comments

Leave This Blank:


30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit Submit and Print

* indicates a required field