35th WARD SERVICE REQUEST

Dear 35th Ward Neighbors:

We are happy to make this service request form vailable to you online. You can utilize this form to file a service request in the same way that you would by phone or by visiting our office - except this format will allow you to complete a request 24 hours a day, seven days a week.

Sincerely,

Rey Colón, Alderman 35th Ward

SERVICE REQUEST & AUTHORIZATION FORM

STEP #1: Choose a service request category to ensure prompt, accurate delivery and attention.

STEP #2: Now, please tell us the exact location, business name, and contact person (where applicable) for the service you are requesting. Leave fields blank where unknown.

Business Info:
First, Last Name:
Exact Address: *	[?]
Location Type:	Residential Address Business Alley Other

STEP #3: Next, please describe in detail the problem requiring service in the space below.

STEP #4: Your signature, email address, and optional contact information.

*SIGNATURE: *DATE: By signing the above, I attest that the information is correct to the best of my knowledge and agree to the terms and conditions of submitting this request to Alderman Rey Colón's 35th Ward Office.
*Email Address: Telephone Number:
Your Street Address & ZipCode:
Yes, the address on this request () is MY address.
Yes! Please include me on Alderman Colón's 35th Ward email newsletter & update list.