Form Center

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.
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 pickup issues
    5. Parks issues
    6. Blocked sewer line
    7. Stormwater Pollution
    8. Street Lights

    1. Damaged sidewalk
    2. Nuisance issues (noise, etc.)
    3. Storm sewer leaking/blockage
    4. Water leaking on road
    5. Manhole cover issue
    6. Crime/safety issues
    7. Illegal dumping
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