City of Nampa Form Center

2. First Name*
3. Last Name*
5. Address1*
7. City*
8. State*
9. Zip*
11. Phone Number*
12. Email Address
14. Location of concern, please include cross streets and the pole ID number if available.*
16. Brief Description*
18. Disclaimer
    We will make every effort to respond to your claim in a timely manner. If your concern is not an emergency, please allow three business days for a response call or email. If you do not receive a response you can call 468-5830.
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20. 1. Receive an email copy of this form.
21. Email address

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22. Submit

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