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Citizen Request for Services Form

  1. Please use this form to get in touch with us or report an issue such as pothole or street light outtage! We appreciate your feedback. Please do not use this online form for police matters or an emergency. In an emergency, dial 911.
  2. Reported location must be within the Easttown Township. Please be as specific as possible regarding the location or nature of request.
  3. Contact Information
  4. Exact Location of Job Requested
  5. Department*
    Please select a department for the request
  6. Leave This Blank:

  7. This field is not part of the form submission.