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2. The Service Department Report A Concern Form will help us identify an issue in our city. Should a concern require immediate attention, please call us at 440-943-7125. For an emergency, dial 911.

   Thank you for your assistance!

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. Please indicate the nature of your problem by checking the appropriate box(es) below:
22. 1. Traffic signal
    2. Street Lights
    3. Traffic/Road sign
    4. Pothole
    5. Damaged sidewalk

    1. Overhanging trees/shrubs in right-of-way
    2. Water leaking on private property
    3. Water leaking on roadway
    4. Storm sewer leaking/blockage
    5. Loose/protruding manhole cover
24. Brief Description (or other problem not listed)
26. Location of Problem
28. Have a compliment or suggestion?

    We strive to make Wickliffe a better place.  If you have a suggestion or would like to offer a compliment, please fill in the box above!  

    Thank you for taking the time to let us know.  We will respond as soon as possible.

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