City of Long Beach, CA - Service Request

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Saturday, October 11, 2008

> Departments > District 5 > Service Request

How Can We Help You?

Please use this form to make a city service request, comment on an agenda item, ask for additional information about a city program or service, share your comments, or pose a question.

Please select one:

Service Request
Council Agenda Item
Request for Information
Comments and Questions

If you selected "Service Request", select the type of service you need from the list.
(Hold the CTRL-key down while clicking to select multiple items)

Describe the service or information needed:

If you have spoken or written to the City already on this matter, please provide those details:


Please provide your contact information, should we need to reach you regarding your request.
Title	First Name *
Middle	Last *
Daytime Phone *	Ext
Evening Phone	Fax

Address *
City *	State *	Zip *

Email Address *

Confirm your Email Address *

* required field


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Abandoned Shopping Cart
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Alley
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Bees (or other Insects)
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Parking
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Speeding in Neighborhood
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Street Light (Not Traffic)
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Street Sign - Request
Street Sweeping
Traffic Obstruction
Traffic Signal
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