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Citizen's Request

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!

   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:


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

    This field is not part of the form submission.

28. Submit Submit and Print

* indicates a required field