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2. The City of Piedmont FixiT Form will help us identify a problem in your area -- and fix it fast. Should a problem require urgent attention, please call us immediately. For a police emergency, dial 911. Otherwise, call (405) 777-9009 for an after hours water emergency .
   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*
19. Please indicate the nature of your problem by checking the appropriate box(es) below:*

    1. Pothole
    2. Damaged curb
    3. Weeds
    4. Abandoned vehicles
    5. Water leaking

    1. Litter
    2. Blocked drainage channel
    3. Street Lights
    4. Damaged sidewalk
    5. Traffic/Road signs

    1. Overhanging trees/shrubs
    2. Storm sewer leaking/blockage
    3. Water leaking on roadway
    4. Loose/protruding manhole cover
    5. Other
21. If other, please specify
23. Brief Description*
25. Location of Problem*
Leave This Blank:


27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

29. Submit Submit and Print

* indicates a required field